Antiseptic cap that releases a gas such as nitric oxide

ABSTRACT

An antiseptic medical cap that may include a base, a sidewall, and a chamber configured to receive a proximal end of a medical fluid port having an opening. The antiseptic medical cap, in some instances, may include an insert having a gas-releasing anti-microbial compound and/or include a nitric oxide-releasing system that is configured to be positioned at least partially through the opening of the medical fluid port when the antiseptic medical cap receives the proximal end of the medical fluid port into the chamber.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 17/576,842, filed on Jan. 14, 2022, which is acontinuation application of U.S. patent application Ser. No. 16/418,365,filed on May 21, 2019, now U.S. Pat. No. 11,229,746, which is acontinuation application of U.S. patent application Ser. No. 15/637,998,filed on Jun. 29, 2017, now U.S. Pat. No. 10,328,207, which is acontinuation application of U.S. patent application Ser. No. 14/799,022,filed on Jul. 14, 2015, now U.S. Pat. No. 9,707,350, which is acontinuation application of U.S. patent application Ser. No. 13/547,650,filed on Jul. 12, 2012, now U.S. Pat. No. 9,259,535, which is acontinuation-in-part of U.S. patent application Ser. No. 13/288,529,filed on Nov. 3, 2011, now U.S. Pat. No. 9,700,710, which is acontinuation-in-part of U.S. application Ser. No. 12/214,526, filed onJun. 19, 2008, now U.S. Pat. No. 9,707,348, which is acontinuation-in-part of U.S. application Ser. No. 11/821,190 filed onJun. 22, 2007, now U.S. Pat. No. 8,167,847, which claims the benefit ofU.S. Provisional Application Ser. No. 60/815,806 filed on Jun. 22, 2006,and U.S. patent application Ser. No. 13/288,529 is acontinuation-in-part of U.S. application Ser. No. 11/821,190 filed onJun. 22, 2007, now U.S. Pat. No. 8,167,847, which claims the benefit ofU.S. Provisional Application Ser. No. 60/815,806 filed on Jun. 22, 2006,the entire disclosures of each of which are all expressly incorporatedherein by reference.

BACKGROUND OF THE INVENTION Technical Field

The present invention relates to an antiseptic cap equipped syringe, andmore specifically to antiseptic caps disposed on syringes.

Background Art

Catheters are widely used to treat patients requiring a variety ofmedical procedures. Catheters can either be acute, or temporary, forshort-term use or chronic for long-term treatment. Catheters arecommonly inserted into central veins (such as the vena cava) fromperipheral vein sites to provide access to a patient's vascular system.Catheters offer many advantages for patients; for example, chroniccatheters provide ready access without repeated punctures or repeatedvessel cannulation for administration of large volumes of fluids,nutrients and medications and for withdrawal of blood on an intermittentbasis. With respect to the use of catheters for infusion of fluids,examples include the infusion of drugs, electrolytes or fluids used inchemotherapy. In chemotherapy, catheters are used for infusion of drugson an intermittent basis, ranging from daily to weekly. Another exampleincludes the use of catheters in hyperalimentation treatment, whereinthe catheters are usually used for infusion of large volumes of fluids.

For hemodialysis, catheters are commonly used—usually three times perweek—for aspiration of blood for dialysis treatment and rapid return ofthe blood to circulation after treatment. Although a preferred mode ofvascular access for a hemodialysis patient involves using anarteriovenous (AV) fistula of either the upper or lower extremities oran arteriovenous “bridge” graft (typically utilizing PTFE), use of theseaccess devices is not always possible or desirable. When either of thesemodes of vascular access is not available, for example, due to a paucityof adequate blood vessels for creation of AV “shunts” or due tononoptimally functioning established AV shunts, a large bore venous linecatheter is typically required for hemodialysis. Catheters used forhemodialysis usually include two relatively large diameter lumens(usually molded as one catheter) for aspiration and rapid return ofblood required during the hemodialysis procedure. One lumen of such acatheter is used for aspiration, or removal, of blood, while the otherlumen is used for returning the blood to the patient's bloodstream.

Catheter connections, such as, for example, connections of catheters todialysis machine tubing, to IV line tubing, to infusion ports and tocatheter caps, which are used to seal the end of a catheter to protectthe sterility of the catheter and prevent fluid loss and/or particlecontamination, are most often made utilizing the medical industry'sstandardized Luer taper fittings. These fittings, which may either bemale couplings or female couplings, include a tapered end ofstandardized dimensions. Coupling is made by the press-fit of matingparts. A threaded lock-fit or other type of securing mechanism iscommonly utilized to ensure the integrity of the pressure fit of theLuer fittings.

Catheters, especially chronic venous catheters, provide challenges intheir use. One such challenge is that such catheters can become occludedby a thrombus. In order to prevent clotting of catheters in bloodvessels between uses, such as, for example, between dialysis treatmentswhen the catheter is essentially nonfunctioning and dwells inside a“central” vein (i.e. superior vena cava, inferior vena cava, iliac,etc.), the lumens of the catheter are often filled with a lock solutionof a concentrated solution of the commonly used anticoagulant, heparin(up to 10,000 units of heparin per catheter lumen).

As used herein, the terms “lock solution” or “locking solution” refer toa solution that is injected or otherwise infused into a lumen of acatheter with the intention of allowing a substantial portion of thelock solution to remain in the lumen and not in the systemic bloodcirculation until it is desired or required to access that particularlumen again, typically for additional treatment, i.e., infusion orwithdrawal of fluid. In addition, attention has been given to thedevelopment of alternative lock solutions with the goal of improving thepatency rates of vascular catheters. For example, lower-alcoholcontaining locking solutions are under development wherein the loweralcohols include ethanol, propanol and butanol. Antimicrobial and/oranticoagulant additives can optionally be added to the lower-alcoholcontaining locking solution. Preferably the lock solution can remain inthe lumen for a desired amount of time lasting from about 1 hour to 3 or4 days or longer.

For the reasons set forth above, significant care must be taken wheninfusing medications, nutrients and the like into a catheter, and when“locking” a catheter between uses, to minimize the risks associated withan indwelling catheter, including the risk of thrombosis or clotting,the risk of excessive anticoagulating and the risk of infection.Syringes are typically used to administer the required amount ofcatheter lock solution (determined by the catheter manufacturer) into anindwelling catheter after a given use. Flush procedures also requirethat care be taken to prevent blood reflux into the catheter. Reflux inI.V. therapy is the term commonly used to describe the fluid that isdrawn back into the catheter after a flush procedure. The concern isthat the reflux fluid contains blood or solution that could cause thecatheter to occlude. To ensure that reflux does not occur, flushprocedures suggest two techniques: 1) at the end of the flush solutiondelivery, the user maintains pressure on the syringe plunger whileclamping the I.V. line; or 2) while delivering the last 0.5 ml of flushsolution disconnect the syringe from the I.V. port or clamp the I.V.line. Either technique maintains positive pressure on the fluid in thecatheter to prevent reflux of fluid and blood.

It has been found that the use of antiseptic caps, such as the capmanufactured and sold by Excelsior under the trademark SwabCap, greatlyreduce the incidence of infections, resulting in, among other things,significant health benefits for patients and vast cost savings.

In light of the above-described problems, there is a continuing need foradvancements in catheter lock techniques, devices and procedures toimprove the safety and efficacy of catheter locking procedures and ofoverall patient care.

SUMMARY OF THE INVENTION

The present invention relates to an antiseptic cap and syringecombination. The combination includes a syringe barrel having an accesspoint connection, and a tip cap having a proximal chamber and a distalchamber. The proximal chamber releasably receives and engages the accesspoint connection of the syringe. The distal chamber removably receivesand engages an antiseptic cap. In one embodiment, the distal chamber hasa plurality of ribs for coacting with a plurality of ribs on theantiseptic cap to prevent relative rotational movement between thedistal chamber and the antiseptic cap.

In one embodiment, a combination syringe tip cap and antiseptic capincludes a first chamber having means for releasably engaging an accesspoint connection on a syringe. A second chamber is formed integrallywith the first chamber. An antiseptic cap is positioned within thesecond chamber, and means for releasably engaging the antiseptic cap isprovided in the second chamber.

A method of storing an antiseptic cap of a syringe is provided. Themethod includes the steps of providing a syringe having a barrel, aplunger, an access point connection and a tip cap, providing a chamberon the syringe, and releasably engaging an antiseptic cap within thechamber.

A method of using an antiseptic cap disposed on a tip cap of a syringehaving a barrel, a plunger, an access point connection and a tip cap isalso provided. The method includes the steps of removing the tip capfrom the syringe, and using the syringe. The method further includes thestep of removing a cover over the antiseptic cap. Steps of using a tipcap to position the antiseptic cap on an access point, and removing thetip cap from engagement with the antiseptic cap, leaving the antisepticcap on the access point are included.

In one embodiment, a combination syringe tip cap and antiseptic capincludes a first chamber having means for releasably engaging an accesspoint connection on a syringe, and a second chamber formed integrallywith the first chamber. An antiseptic cap assembly has an antisepticcap, and the antiseptic cap assembly is removably positioned within thesecond chamber.

In another embodiment, an antiseptic cap and syringe combinationincludes a syringe barrel having an access point connection, and aplunger received at one end by the barrel. The plunger has a chamberremoveably receiving an antiseptic cap assembly at a second end. A tipcap has a proximal chamber for releasably receiving the access pointconnection of the syringe, and a distal chamber for removeably receivinga second antiseptic cap assembly.

In another embodiment, an antiseptic cap and syringe combinationincludes a syringe barrel having an access point connection, and aplunger received at one end by the barrel. A chamber is interconnectedwith the syringe barrel for removeably receiving an antiseptic capassembly.

In another embodiment, an antiseptic cap and syringe combinationincludes a syringe barrel having an access point connection and anantiseptic cap. A flexible ring for engaging the access point, and achamber interconnected with the syringe barrel for removeably receivingan antiseptic cap are provided.

In another embodiment, an antiseptic cap and syringe combinationincludes a syringe barrel having an access point connection and a tipcap including a proximal chamber releasably receiving and engaging theaccess point connection of the syringe. A distal projection extends fromthe tip cap, and an antiseptic cap assembly has a chamber for receivingthe distal projection of the tip cap at one end and an antiseptic cap atthe other end.

In another embodiment, an antiseptic cap and syringe combinationincludes a syringe barrel having an access point connection, a tip capincluding a proximal chamber for engaging the access point connectionand a distal attachment chamber, and a cap assembly. The cap assemblyincludes an engagement protrusion for removeably engaging the tip cap.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an antiseptic cap equipped plunger andsyringe barrel assembly prior to connection of a syringe tip to anaccess point to a central venous catheter;

FIG. 2 is a perspective view of an antiseptic cap equipped plunger andsyringe barrel assembly with the syringe tip connected to an accesspoint to a central venous catheter;

FIG. 3 is a perspective view of an antiseptic cap equipped plunger andsyringe barrel assembly prior to connection of the antiseptic cap to anaccess point to a central venous catheter;

FIG. 4 is a perspective view of an antiseptic cap equipped plunger andsyringe barrel assembly after connection of the antiseptic cap to anaccess point to a central venous catheter;

FIG. 5 is a perspective view assembly drawing of an antiseptic capequipped plunger;

FIG. 6 is a perspective view of an antiseptic cap equipped plunger in apartially assembled state;

FIG. 7 is a perspective view of the antiseptic cap equipped plunger ofFIG. 6 with a top seal;

FIG. 8 is a perspective view of an antiseptic cap equipped plunger ofFIG. 7 mounted in a lumen of a syringe barrel;

FIG. 9 is a side view in cutaway of an antiseptic cap equipped plungerand syringe barrel assembly;

FIG. 10 shows an exploded view of a detail of FIG. 9 of one embodimentof the antiseptic cap equipped plunger and syringe barrel assembly;

FIG. 11 shows an exploded view of a detail of FIG. 9 of anotherembodiment of the antiseptic cap equipped plunger and syringe barrelassembly;

FIGS. 12-14 show various embodiments of grips of the antiseptic capequipped plunger assembly;

FIGS. 15-17 show various views of one embodiment antiseptic cap equippedplunger and syringe barrel assembly with a barrel lock to resistrotation of the plunger assembly with respect to the syringe barrel;

FIG. 18 shows another embodiment of a barrel lock to resist rotation ofthe plunger assembly with respect to the syringe barrel;

FIGS. 19-20 show various views of another embodiment antiseptic capequipped plunger and anti-reflux syringe barrel assembly with a barrellock to resist rotation of the plunger assembly with respect to thesyringe barrel;

FIG. 21 shows a perspective view of another embodiment antiseptic capequipped plunger and syringe barrel assembly with a barrel lock toresist rotation of the plunger assembly with respect to the syringebarrel;

FIG. 22 a,b are respectively a perspective view of an antiseptic capwithout a sponge and with a sponge;

FIGS. 23 and 24 are different embodiments of the antiseptic cap withvarying gripping features;

FIG. 25 is a perspective view of the antiseptic cap of FIG. 22 b priorto docking with a valve;

FIG. 26 is a perspective view of the antiseptic cap of FIG. 22 b dockedwith a valve;

FIG. 27 is a side view in cutaway of the antiseptic cap and valveassembly shown in FIG. 26 ;

FIGS. 28-30 are side views in cutaway of two different embodiments ofthe antiseptic cap;

FIGS. 31 a,b are, respectively, side views in cutaway showing anantiseptic cap with a centrally disposed actuation post mounted on avalve with the valve in the unactivated and activated positions;

FIGS. 32 and 33 are side views in cutaway showing two differentembodiments of an antiseptic cap having a molded sponge;

FIG. 34 is a side view in cutaway showing another embodiment of anantiseptic cap having a molded sponge docked to a valve;

FIG. 35 is a side view in cutaway showing a step of attaching a moldedsponge to an antiseptic cap;

FIG. 36 is a side view in cutaway showing a step of delivering anantiseptic compound to a molded sponge positioned within a cap;

FIG. 37 shows a side view in cutaway of an antiseptic cap docking to avalve with the antiseptic cap having an antiseptic coating;

FIG. 38 shows a perspective view of an antiseptic cap in a blisterpackage;

FIG. 39 is a side cross-sectional view of an antiseptic cap with athread cover;

FIG. 40 is a side cross-sectional view of an antiseptic cap with athread cover;

FIG. 41 is a side cross-sectional view of an antiseptic cap with athread cover;

FIGS. 42 a,b are perspective front and back views of an antiseptic capwith a thread cover connected to a Cardinal SMART SITE access site;

FIGS. 43 a,b are perspective front and back views of an antiseptic capwithout a thread cover connected to a Cardinal SMART SITE access site;

FIGS. 44 a,b are perspective front and back views of an antiseptic capwith a thread cover connected to a Hospira (ICU) C1000 Clave accessdevice;

FIGS. 45 a,b are perspective front and back views of an antiseptic capwithout a thread cover connected to a Hospira (ICU) C1000 Clave accessdevice;

FIGS. 46 a,b are perspective front and back views of an antiseptic capwith a thread cover connected to a B. Braun ULTRASITE access device;

FIGS. 47 a,b are perspective front and back views of an antiseptic capwithout a thread cover connected to a B. Braun ULTRASITE access device;

FIGS. 48 a,b are perspective front and back views of an antiseptic capwith a thread cover connected to a Rymed INVISION PLUS access device;

FIGS. 49 a,b are perspective front and back views of an antiseptic capwithout a thread cover connected to a Rymed INVISION PLUS access device;

FIG. 50 is a side cross-sectional view of an antiseptic cap with athread cover connected to a Cardinal SMARTSITE PLUS access device;

FIG. 51 is a side cross-sectional view of an antiseptic cap with athread cover connected to a Cardinal SMARTSITE PLUS access device andthe thread cover having a reduced diameter when compared to the threadcover shown in FIG. 50 ;

FIG. 52 is a side cross-sectional view of an antiseptic cap with athread cover connected to a Hospira (ICU) C1000 Clave access devicehaving a thread cover with an alternative profile;

FIG. 53 is an assembly view of an antiseptic cap and cup holder equippedplunger and syringe barrel system;

FIG. 54 is an assembly view of a cup-holder-antiseptic cap assemblyadjacent a plunger and syringe barrel system;

FIG. 55 is a side view in cross-section of an antiseptic cap and cupholder equipped plunger and syringe barrel assembly;

FIG. 56 a is a perspective view of a medical access device adjacent anantiseptic cap equipped plunger and syringe barrel assembly with a lidstock peeled back in preparation for docking;

FIG. 56 b is a perspective view of a medical access device docked to anantiseptic cap equipped plunger and syringe barrel assembly;

FIG. 56 c is a perspective view of a medical access device docked to anantiseptic cap adjacent a plunger and syringe barrel assembly;

FIG. 57 is an enlarged view of a cup holder and antiseptic cap assemblyadjacent an open and empty chamber of a syringe plunger;

FIG. 58 is an enlarged view of a cup holder and antiseptic cap assemblypositioned within a chamber of a syringe plunger;

FIG. 59 is a perspective view of an alternative embodiment of anantiseptic cap assembly adjacent a syringe plunger and barrel assembly;

FIG. 60 is a perspective view of an alternative embodiment of anantiseptic cap assembly docked to a syringe plunger and barrel assembly;

FIG. 61 is a perspective view of an alternative embodiment of anantiseptic cap assembly docked to a syringe plunger and barrel assemblywith an outer wall being transparent to reveal interior portions of theassembly;

FIG. 62 is a perspective view of a tip cap assembly having an antisepticcap attached to a syringe;

FIG. 63 is a cross-sectional view of a tip cap having an antiseptic capattached to a syringe;

FIG. 64 is an exploded, perspective view showing an antiseptic cap and atip cap;

FIG. 65 is an exploded, perspective view showing an antiseptic capholder assembly, a tip cap, and a syringe;

FIG. 66 is an exploded, perspective view showing an antiseptic capholder assembly, a tip cap, and a syringe;

FIG. 67A is a cross-sectional view of an antiseptic cap assemblyattached to a syringe;

FIG. 67B is a cross-sectional view of an antiseptic cap assembly and aflexible cap;

FIG. 68 is a side view of an antiseptic cap holder assembly attached toa tip cap attached to a syringe;

FIG. 69 is a perspective view of an antiseptic cap holder assembly;

FIG. 70 is a perspective view of a tip cap;

FIG. 71 is a cross-sectional view of the antiseptic cap holder assemblyof FIG. 69 and the tip cap of FIG. 70 disengaged and unlocked;

FIG. 72 is a cross-sectional view of the antiseptic cap holder assemblyof FIG. 69 and the tip cap of FIG. 70 engaged and locked;

FIG. 73 is a perspective view of a syringe having a plunger with a capholder assembly that is manually removable from the plunger;

FIG. 74 is a cross-sectional view of the syringe, plunger, and capholder assembly of FIG. 73 ;

FIGS. 75 and 76 are sequential views, showing the process of manuallyremoving the cap holder assembly from a chamber of the plunger;

FIG. 77 is a perspective view of another embodiment of a chamber of aplunger with ribs having grooves;

FIG. 78 is a cross-sectional view of the chamber of FIG. 77 ;

FIG. 79 is a cross-sectional view of a cap holder assembly positionedwithin the chamber shown in FIG. 78 ;

FIG. 80 is a cross-sectional view of a cap holder assembly partiallyremoved from the chamber shown in FIG. 78 ;

FIG. 81 is a cross-sectional view of another embodiment of a chamber ofa plunger with ribs having two sets of grooves;

FIG. 82 is a cross-sectional view of a cap holder assembly positionedwithin the chamber shown in FIG. 81 ;

FIG. 83 is a cross-sectional view of a cap holder assembly partiallyremoved from the chamber shown in FIG. 81 ;

FIG. 84 is a perspective view of another embodiment of a plunger havingsidewalls with recessed areas;

FIG. 85 is a perspective view of another embodiment of a plunger havingtwo or more sidewalls positioned at angles of greater than ninetydegrees from each other to provide access to the chamber;

FIG. 86 is a perspective view of another embodiment of a syringe havinga flange with receptacles for receiving a cap holder assembly;

FIG. 87 is a perspective view of the syringe shown in FIG. 86 with a capholder assembly positioned in a receptacle;

FIG. 88 is a perspective view of a flange connector panel having a capholder assembly receptacle and a flange slot in a sidewall;

FIG. 89 is a top view of the flange connector panel of FIG. 88 connectedto a gripping flange of a syringe;

FIG. 90 is a perspective view of another embodiment of a flangeconnector panel having a flange slot in another sidewall;

FIG. 91 is a top view of the flange connector panel of FIG. 90 connectedto a gripping flange of a syringe;

FIG. 92 is a perspective view of another embodiment of a syringe with agripping flange having engagement teeth;

FIG. 93 is a perspective view of a flange connector panel that engageswith the gripping flange of FIG. 92 ;

FIG. 94 is a perspective view of another embodiment of a flangeconnector panel for connection with a gripping flange having a lip;

FIG. 95 is a perspective view of a flange connector panel that attachesto the gripping flange of FIG. 94 ;

FIG. 96 is a perspective view of a plunger and cap holder assemblyconnected by a frangible attachment;

FIG. 97 is a cross-sectional view of the plunger and cap holder assemblyof FIG. 96 ;

FIG. 98 is an exploded view of a plunger having a transverse opening toreceive a cap holder assembly;

FIG. 99 is an exploded view of another embodiment of a plunger having atransverse opening for receiving a cap holder assembly;

FIG. 100 is a front view of the plunger of FIG. 99 ;

FIG. 101 is a side view of the plunger of FIG. 99 ;

FIG. 102 is a perspective view of another embodiment of a cap holderassembly having a locking flange;

FIG. 103 is a partial perspective view of a plunger having a lockingchamber;

FIG. 104 is a partial cross-sectional view of the cap holder assembly ofFIG. 102 and the plunger of FIG. 103 disengaged and unlocked;

FIG. 105 is a cross-sectional view of the cap holder of the cap holderassembly of FIG. 102 and the plunger of FIG. 103 engaged and locked;

FIG. 106 is a perspective view of another embodiment of a plunger havinga locking lever and a cap holder assembly disposed therein;

FIG. 107 is a cross-sectional view of the plunger and cap holderassembly of FIG. 106 ;

FIG. 108 is a side view of the locking lever of FIGS. 106 and 107 ;

FIG. 109 is a cross-sectional view of another embodiment of the plungerand cap holder assembly that includes a locking lever with a toe;

FIG. 110 is a side view of the locking lever of FIG. 109 ;

FIG. 111 is a side view of a cap holder assembly and a plunger eachhaving an adhesive material thereon;

FIG. 112 is a side view of a cap holder assembly and a plunger withcompressible material in an uncompressed state;

FIG. 113 is a side view of a cap holder assembly and plunger with thecompressible material in a compressed state;

FIG. 114 is a cross-sectional view of a plunger and a cap holderassembly, wherein the cap holder assembly flange is positioned adistance away from the plunger flange;

FIG. 115 is an exploded view of a plunger having a locking flangeattached thereto and a cap holder assembly;

FIG. 116 is a perspective view of the plunger and the cap holderassembly of FIG. 115 disposed in the plunger;

FIG. 117 is a top view of the locking flange of FIGS. 115 and 116 ; and

FIG. 118 is a top view of another embodiment of the locking flange ofFIGS. 115 and 116 .

DETAILED DESCRIPTION OF THE INVENTION

While this invention is susceptible of embodiment in many differentforms, there is shown in the drawings, and will be described herein indetail, specific embodiments thereof with the understanding that thepresent disclosure is to be considered as an exemplification of theprinciples of the invention and is not intended to limit the inventionto the specific embodiments illustrated.

FIGS. 1 and 2 show an antiseptic cap equipped plunger and syringe barrelassembly 10 having an antiseptic cap equipped plunger (or piston)assembly 12 and a syringe barrel 14. The barrel 14 has a side wall 16defining a chamber 18 and the barrel has a proximal end 20 and a distalend 22. The proximal end 20 has an opening 22 to the chamber 18 and aflange 24 extending radially outwardly from the wall 16. The flange 24has upper and lower surfaces 26, 28 and provides gripping surfaces for auser of the assembly 10. The distal end 22 of the barrel 14 has an endwall 30 and an elongate tip 32 extending distally therefrom and having apassageway 34 therethrough and in fluid communication with the chamber18. The distal end wall 30, in one preferred form of the invention, isgenerally conically shaped and, as is well known in the art, can have alocking luer collar 35 concentrically surrounding the tip 32 and havinga set of threads 37 on an inside surface thereof. The luer collar 35allows for attaching a needle or a cannula to the syringe assembly andfor docking the assembly to mating threads located on other devices suchas valves and injection sites. FIG. 1 shows the syringe assemblyproximate an access site 38 having a valve 39 controlling access to alumen of a tubing 41.

In one preferred form of the invention the chamber 18 of the syringeassembly 10 will be filled with a locking solution or a flush solutionfor use with an indwelling, central venous catheter. The manner of usinga locking or flush solution with a catheter is well known in the art.Suitable locking or flushing solutions will be set forth below. Theflush or locking solution is injected into a fluid access site of thecatheter to clean and disinfect the catheter and can be withdrawn fromthe catheter or allowed to remain in an end portion of the catheter toserve as a barrier to the ingress of pathogens and contaminants.

The antiseptic cap plunger assembly 12 has an elongate shaft 40, aproximal end 42 and a distal end 44. The elongate shaft 40, in onepreferred form of the invention, is generally cruciform incross-sectional shape. A stopper or piston 50 is connected to the distalend 44 of the plunger 12. The piston 50 is dimensioned such that wheninserted into the syringe barrel chamber 18 an outer circumferentialsurface of the piston is in fluid-tight engagement with an inner surface54 of the syringe barrel. The piston assembly 12 when moved proximally(or when being withdrawn) can draw fluid into the chamber and when moveddistally (or when inserted into the syringe chamber) can drive fluid outof the chamber. FIG. 1 shows the piston assembly 12 partially insertedinto the syringe chamber and FIG. 2 shows the piston assembly fullyinserted into the syringe chamber to deliver fluid to the tubing 41.

A housing 60 is located at the proximal end of the plunger assembly 12and has a wall 62 defining a chamber 64 having an open end 66 which canbe sealed by any suitable structure or material such as a cap or by afoil material 68. An optional annular flange 70 extends radiallyoutwardly from the wall 62 and provides a surface upon which the sealingstructure can be attached.

FIG. 5 shows a cap assembly 80 proximate the chamber 64 of the housing60 and FIG. 6 shows the cap assembly 80 positioned within the chamber64. In one preferred form of the invention, the cap assembly 80 has acap 82 having a wall 83 defining a chamber 84 containing an absorbentmaterial 86 such as a sponge. The sponge 86, in a preferred form of theinvention, is wetted or soaked with an agent such as an antiseptic,anticoagulant or antimicrobial (“antiseptic solution”) and can beselected from the locking and flushing solutions set forth below or theantiseptic solutions set forth below. The cap 82 has an interior surface87 with a set of threads 88 for mating with a set of threads on theaccess site 38.

FIGS. 7 and 8 show the cap assembly 80 sealed with a foil material orlid stock material 68 which can be attached to the flange 70 by anysuitable method such as by adhesives or by conductive or inductive heatsealing techniques. FIG. 7 shows the antiseptic cap piston assembly 12and FIG. 8 shows the antiseptic cap equipped piston assembly 12 insertedinto the chamber of the syringe barrel 14 to define the antiseptic capequipped piston and syringe barrel assembly 10.

FIGS. 3 and 4 show one possible method for utilizing the cap assembly 80by docking with the access device 38. FIG. 3 shows the lid stock 68peeled away from the flange 70 and FIG. 4 shows docking the antisepticcap assembly 80 to the valve 39. The syringe barrel is rotated clockwiseor counterclockwise to engage the threads 88 of the antiseptic capassembly 80 with the threads of the access site 38. After engagement,the syringe barrel 14 will be moved away from the access site 38 and theantiseptic cap assembly 80 will slide outward from the housing 60 andremain docked to the access site 38. The antiseptic cap assembly 80 canremain docked to the valve 39 of the access site 38 for any suitableperiod of time from a few minutes to numerous hours. When the antisepticcap assembly 80 is docked to the valve 39 the tubing or catheter 41 issealed to block the ingress into the catheter of pathogens andcontaminants and a portion of the access site 38 is exposed to theantiseptic material in the sponge 86.

It is desirable that during the rotation of the syringe barrel that theantiseptic cap assembly 80 does not rotate with respect to the housingand/or optionally that the plunger assembly 12 does not rotate withrespect to the syringe barrel 14 so that the threads 88 of theantiseptic cap can fully engage the threads of the access site. Thepresent invention provides a mechanism associated with the assembly 10for preventing the rotation of the antiseptic cap assembly 80 withrespect to the plunger assembly 12 and more preferably a mechanism oneither the plunger assembly or on the antiseptic cap 80 to preventrelative rotational movement between the antiseptic cap 80 and theplunger assembly 12. In an even more preferred form of the invention,the mechanism for preventing relative rotation of the antiseptic cap 80with respect to the plunger assembly 12 has mating portions on bothparts that when assembled cooperatively engage one another to preventrelative rotation. It is also contemplated that a separate mechanism,device or member could be used to lock the two parts together to achievethis purpose.

If a user of the assembly 10 grasps the assembly 10 by the antisepticcap and plunger assembly 12 then the interlocking structures between thepiston assembly 12 and the syringe barrel 12 would not necessarily beneeded. Accordingly, FIGS. 5, 9-11 show exemplary structures for lockingthe antiseptic cap assembly 80 inside the housing 60 so that these partsrotate together and one part does not rotate in a direction or at a ratedifferent from that of the other part. Further, FIGS. 15-18 showexemplary structures for interlocking the antiseptic cap plungerassembly 12 with the syringe barrel 14.

In one preferred form of the invention the housing 60 will have afeature or structure that forms an interference fit with an externalsurface 83 of the antiseptic cap 80. Even more preferably, an internalsurface 63 of the side wall 62 of the housing 60 will have a feature orstructure to form an interference fit with a portion of the antisepticcap assembly 80. In another preferred form of the invention theantiseptic cap assembly 80 will have a feature to form an interferencefit with the housing 60 and even more preferably the outer surface 83 ofthe antiseptic cap 80 will have a feature to contact the inner surface63 of the housing side wall 62.

In another preferred form of the invention the plunger housing 60 andthe cap assembly 80 each will have a feature or structure thatcooperatively engage one another to prevent relative rotation of the capassembly 80 and the housing 60. FIG. 5 shows one preferred form of theinvention having a plurality of circumferentially spaced and axiallyextending ribs 100 on the internal surface 63 of the housing side wall62 (internal ribs 100) for engaging the wall 83 of the antiseptic cap 82to lock the cap assembly 80 in place to prevent rotation of the capassembly 80 when positioned inside the housing 60. In a preferred formof the invention, the internal ribs 100 extend from a bottom wall 102 upto an intermediate height of the housing sidewall 62. In a preferredform of the invention the internal ribs 100 will have a height roughlyequal to a height of the cap 82. A plurality of internal slots 108 aredefined between each set of adjacent internal ribs 100. The internalribs 100, in a preferred form of the invention, will have a width thattapers inwardly from proximate the bottom wall 102 to a top 104 of theinternal ribs 100 so that the width of the internal ribs decrease from abottom 106 of a rib to the top 104 of the rib. Also, it is preferablethat the top of the internal ribs 100 have a generally arcuate profileto act as a lead-in during insertion of the antiseptic cap assembly 80into the housing 60. In a preferred form of the invention, the internalribs 100 will terminate short of a top 113 of the housing sidewall 62 todefine an annular gap 111 between the top of the rib 104 and the top113. Also, extending radially inwardly from the internal surface 63 ofthe cap 82 is a detent 109 positioned proximate a top portion 113 of theside wall 62.

The antiseptic cap 82 has a plurality of circumferentially spaced andaxially extending ribs 120 extending along an external surface 122 ofthe cap 82 (external ribs 120) from an annular flange 123. The externalribs 120 are dimensioned for engaging a portion of the interior wall ofthe housing 62 to prevent relative rotation of the cap and the plungerassembly 14 and define a plurality of external slots one of each betweeneach adjacent pair of external ribs. When the cap 82 is positionedwithin the chamber 64 (FIGS. 9 and 11 ) each of the external ribs 120are positioned within an internal slot 108 and each of the internal ribsare positioned within an external slot to lock together these parts toassure that the cap rotates in the same direction as the plunger rod.FIGS. 6 and 11 also show that when the cap 82 is positioned within thehousing 60, the detent 109 contacts the annular flange 123 to hold thecap in the housing to prevent or resist inadvertent dropping of the capfrom the housing prior to docking of the cap with the access site. Inone preferred form of the invention, the external ribs 120 arespecifically designed in conjunction with internal slots 108 so that theantiseptic cap is guided out of the storage chamber 64 as the cap isscrewed onto the threads of the access site.

FIGS. 12-14 show several embodiments of gripping surfaces on the housing60 (with lid stock 68 removed) to facilitate use of the assembly 10 orthe plunger assembly 12. FIG. 12 shows axially extending andcircumferentially spaced protuberances 130 on an outer surface of thewall 62. The protuberances 130 can have numerous differentcross-sectional shapes including circular, polygonal, oval and irregularand, in a preferred form of the invention, extend from the flange 70 toa bottom of the housing.

FIG. 13 shows a housing 60 that has no flange 70 and has protuberances130 on the wall 62 extending substantially the entire height of thehousing 60. FIG. 14 shows a housing 60 where the outer surface of thewall 62 is relatively smooth but has a series of circumferentiallyspaced and axially extending protuberances 130 on a circumferential edgeof the flange 70.

As with the cap and plunger assembly rotational locking features orstructures, the optional plunger assembly 12 and syringe barrel 14locking feature or structure can be positioned alone on the plungerassembly 12, or alone on the syringe barrel 14 or have cooperatingstructures on both the plunger assembly 12 and the syringe barrel 14. Itis also contemplated that a separate mechanism, device or member couldbe used to lock the two parts together to achieve this purpose.

FIGS. 15-18 show various embodiments for the optional feature of lockingthe plunger assembly 12 from rotational motion with respect to thesyringe barrel 14. In one embodiment shown in FIGS. 15-17 and 21 a wing150 extending axially along an outside surface of the housing side wall62 engages a tooth 152 positioned on an interior surface of the syringebarrel at is proximal end. More preferably, the plunger assembly 14 willhave more than one wing 150 with each wing being circumferentiallyspaced from the other. In an even more preferred form of the inventionthe plunger assembly will have four wings 150 spaced 90 degrees from oneanother. Also, in a more preferred form of the invention, the syringebarrel will have a plurality of circumferentially spaced teeth. When theplunger assembly is nearly fully inserted into the syringe barrel eachof the wings will extend into a tooth to prevent rotation of the plungerassembly 12 with respect to the syringe barrel 14.

FIG. 18 shows another embodiment of a locking feature to preventrotation of the plunger assembly 12 with respect to the syringe barrel14 and also prevents relative translational motion of the parts. In thisembodiment an annular protuberance 160 positioned on an interior surfaceof the syringe barrel at its proximal end 20 engages an annular detent162 on an outside surface of the plunger rod.

FIGS. 19 and 20 show an antiseptic cap equipped plunger assembly 12 andnon-refluxing syringe assembly 170. Non-refluxing syringes are wellknown in the art and there are numerous methodologies for reducingreflux while accessing the access site of a central venous catheter. Inthis embodiment the annular flange 70 of the plunger assembly 12 abutsthe flange 24 of the syringe barrel prior to the piston 50 contacting aninterior surface of the syringe distal end wall 30.

It is contemplated that the antiseptic cap assembly 80 of the presentinvention need not be coupled or combined with a plunger or a syringebarrel. FIGS. 22 a,b show a stand-alone antiseptic cap assembly 200having three circumferentially spaced ribs 120 for grasping by the handof a user of the cap assembly. FIG. 22 a shows the cap 82 without anabsorbent material 86 and FIG. 22 b shows the cap with an absorbentmaterial. The cap 200 can be used for the same purposes of the capassembly 80 described above but will be used by hand. All other featuresof the cap 200 are essentially the same as described above with theexception that the cap 200 does not have to be dimensioned to fit withina chamber carried by a syringe plunger. FIGS. 23 and 24 show varyingfrequency of ribs 120 and varying shapes and sizes.

FIG. 25 shows the cap 200 proximate the access site 38 and FIGS. 26 and27 show the cap 200 docked to the access site 38.

A suitable absorbent material 86 includes medical grade materialscapable of storing and releasing an antiseptic liquid, or liquid havingother medical purposes, and includes materials such as sponges,rupturable capsules and other materials or devices capable of servingthis purpose. Suitable sponges can include any sponge suitable for usefor medical purposes and can be naturally occurring or synthetic. Thesponges can be die cut into suitable shapes or can be molded into thedesired shape. It is desirable that the sponge 86 be attached to theantiseptic cap 82 to prevent the sponge 86 from inadvertently fallingout of the cap 82. FIG. 28 shows the sponge 86 is captured between anannular wall 202 and a disc 204 attached to the cap 82 by any suitablemethod such as ultrasonic or vibrational welding or other techniqueswell known in the art.

FIGS. 29 and 30 show a variation on the cap assembly 200 of FIG. 28 . Inthis embodiment, the sponge is retained in the cap 82 with a plasticsheet 206 heat welded to the cap. In one preferred form of the inventionthe sponge is attached by an adhesive or by other method to form anassembly which is then attached to the cap.

FIGS. 31 a,b show the cap 200 having a coaxially disposed and axiallyextending actuating post 220 circumferentially surrounded by a sponge 86having a centrally positioned hole to fit over the post 220. FIG. 31 ashows the cap 200 in initial engagement with the access site 38 and FIG.31 b shows the cap threaded onto the access site 38 and the actuatingpost opens the valve 39 and antiseptic fluid is allowed to flow into thevalve.

FIGS. 32-34 show varying shaped sponges that, in one preferred form ofthe invention, were molded into various desirable shapes. The sponge ofFIG. 34 has a central opening 230 to facilitate attaching the sponge tothe cap and to filling the sponge with antiseptic, anticoagulant orother suitable fluids set forth above. FIG. 35 shows the cap having acentrally disposed energy director 231, an ultrasonic welder 232 beingbrought into cooperative engagement with the sponge on a side of thesponge opposite the energy director 231. By applying ultrasonic energythe energy director 231 melts and attaches the sponge to the cap. FIG.36 shows a filling device 240, having a lumen 242 and a dispensing head244 in fluid communication with a source of antiseptic, anticoagulant orthe like for dispensing a metered amount of such fluid into the interiorportion of the sponge.

FIG. 37 shows an alternative embodiment of the antiseptic cap 200 wherethe sponge is replaced by an antiseptic coating on the actuating post220.

FIG. 38 shows the antiseptic cap 200 positioned in a blister pack 233prior to sealing the blister pack.

FIG. 39 shows an antiseptic cap 300 with a thread cover 302. The threadcover 302 can be part of any of the antiseptic caps discussed herein.The thread cover 302 is made of a deformable material capable of flexingupon application of moderate force applied by hand. In one preferredform of the invention the thread cover 302 is made from a polymericcontaining material and more preferably a polymeric material having amodulus of elasticity of less than 20,000 psi. In another preferred formof the invention the polymeric material will be an elastomer orplastomer or like material. The thread cover 302 enhances the connectionbetween the antiseptic cap 300 and a device such as a valve or otheraccess devices 38. The thread cover 302 provides a physical barrier tothe ingress of pathogens, dust or other contaminants through the matingthreads of the antiseptic cap 300 and the access device or valve towhich it is docked. The thread cover 302 also serves to retainantiseptic fluids from the antiseptic cap 300 from leaking out throughthe threads. The thread cover can be made a part of the antiseptic cap300 using techniques well known in the art such as overmolding, or byattaching as a separate part using welding techniques such as heatconductive welding, heat induction welding, vibrational welding, stretchor friction fit, or by using a suitable adhesive.

The thread cover 302 can provide a universal fit to most commerciallyavailable valves, connectors and access devices, or the thread cover 302can be customized to dock with a particular access device.

FIG. 39 shows, as is described above, the antiseptic cap 300 has anannular wall 305 having a first end 306 and a second end 320 with thefirst end having a greater diametrical dimension than the second end.The annular wall defines a central chamber 322 having an open end 323.In one preferred form of the invention, the chamber 322 will have asponge 86 positioned therein as shown in FIGS. 5 and 6 above, althoughit is not shown in FIG. 39 . The thread cover 302 is shown attached byan optional bonding layer 304 to the first end 306 of the annular wall305. The thread cover 302 has a first leg 308 and a second leg 310. Thefirst leg 308 extends parallel to the annular wall 305 and the secondleg 310 extends radially inwardly from the annular wall 305 in adirection transverse to the first leg 308 and across a portion of theopen end 323 and defines a central opening 312, having a reduceddiameter when compared to the open end 323, into the chamber 322. Thesecond leg 310 terminates at a distal end 330 with a rounded outersurface 332.

FIG. 40 shows an alternative embodiment of the antiseptic cap 300 havingthe thread cover 302 having both the first and second legs 308, 310attached to the first end 306 of the annular wall 305 through bondinglayers 304 a,b. A top surface 340 of the first end 306 is shown havingthe same thickness or diametrical dimension as the remainder of thefirst end but it is contemplated the top surface could have a radiallyextending flange 123 as shown in FIG. 5 .

FIG. 41 shows an alternative embodiment of the antiseptic cap 300 thatdiffers from the antiseptic cap shown in FIGS. 39 and 40 by notincluding a counterbore 336 shown in these figures. The counterbore 336provides a chamber of reduced diameter and, therefore, will form atighter fit with access devices with a narrower outer diameter whencompared to the cap shown in FIG. 41 which does not include thecounterbore. This is just one example of the modifications that can bemade to the geometry of the antiseptic cap to enhance the connectionbetween the cap and an access site.

FIGS. 42 a,b show front and back views of the antiseptic cap 300 withthe thread cover 302 connected to a Cardinal SMART SITE access site 350.FIGS. 43 a,b are perspective front and back views of the antiseptic capwithout the thread cover 302 connected to the Cardinal SMART SITE accesssite.

FIGS. 44 a,b are perspective front and back views of the antiseptic cap300 with the thread cover 302 connected to a Hospira (ICU) C1000 Claveaccess device 352. FIGS. 45 a,b are perspective front and back views ofthe antiseptic cap, without a thread cover 302, connected to the Hospira(ICU) C1000 Clave access device.

FIGS. 46 a,b are perspective front and back views of the antiseptic cap300 with the thread cover 302 connected to a B. Braun ULTRASITE accessdevice 354. FIGS. 47 a,b are perspective front and back views of theantiseptic cap without the thread cover 302 connected to the B. BraunULTRASITE access device.

FIGS. 48 a,b are perspective front and back views of the antiseptic capwith the thread cover 302 connected to a Rymed INVISION PLUS accessdevice; 356. FIGS. 49 a,b are perspective front and back views of theantiseptic cap without the thread cover 302 connected to a RymedINVISION PLUS access device.

FIGS. 50-52 show various embodiments of the thread cover 302. FIG. 50differs from FIG. 51 in that the second leg 310 extends farther acrossthe opening of the chamber in FIG. 51 than shown in FIG. 50 . FIG. 52shows another embodiment of the thread cover 302 having a segmentedsecond leg 310 a,b. This embodiment may be desirable to provide a moreeffective seal for certain access devices.

FIG. 53 shows an exploded view of an alternative embodiment 400 of thesyringe barrel assemblies 10, discussed above, incorporating a capholder 402 into the system of parts. Thus, the alternative assembly andsystem 400 has an antiseptic cap and cap holder equipped plungerassembly 12′, a syringe barrel 14, an antiseptic cap 82 (shown with anoptional thread cover 302), an absorbent material 86, and peelable lidstock 68. FIG. 54 shows an exploded view of an antiseptic cap holderassembly 404 including the cap holder 402 with the antiseptic capassembly 80 positioned within a chamber 406 of the cap holder 402. Thisembodiment 400 allows for the separate manufacture, assembly, andsterilization of the assembly 400 from the plunger assembly and thesyringe barrel.

The cap holder 402 has a proximal and distal ends 408, 410, and an innerwall surface 412 and an outer wall surface 414, an opening 416 into thechamber 406, and a radially outwardly extending flange 418 circumjacentthe opening 416 and extending from the proximal end 408 of the capholder 402. The cap holder 402 will also have an optional bottom wall419.

In a preferred form of the invention, the cap holder 402 or theantiseptic cap 82 will have a structure, element or the like thatprevents the relative rotation of the cap holder 402 and the antisepticcap 82 until the antiseptic cap assembly 80 is securely docked to theaccess device 38. Also, in a preferred form of the invention the capholder 402 or the plunger assembly 12′ will have a structure, element orthe like for preventing the relative rotation of the cap holder 402 andthe plunger assembly 12′ until the antiseptic cap assembly 80 issecurely docked to the access device 38. Any of the anti-rotationdevices discussed above to stop the rotation of the antiseptic capassembly 80 with the plunger assembly 12 would be suitable for, thesepurposes. Also, it is contemplated the devices discussed above inreference to FIGS. 15-21 to prevent the relative rotation of the plungerassembly 12 and the syringe barrel 14 could be incorporated into thisembodiment 400.

FIG. 53 shows the inner wall surface 412 of the cap holder 402 carriesthe internal ribs 100 and the internal slots 108 that interact with theexternal ribs and external slots 120, 122 of the cap 82 as is describedabove with respect to FIG. 5 . These structures prevent or resist therelative rotation of the cap holder 402 with respect to the antisepticcap assembly 80. The term “ribs” referred to herein are structures thatare raised or extend outward from a surface. The term “slots” refer tostructures that extend below a surface or is defined between two ribsand is at a lower level than the ribs.

FIG. 53 also shows an interlocking structure for preventing the relativerotation of the cap holder 402, or the cap holder assembly 404, withrespect to the plunger assembly 12′. The outer wall surface 414 has aplurality of circumferentially spaced and axially extending ribs 420defining slots 424 between each pair of adjacent ribs. In a preferredform of the invention, the ribs 420 are generally triangular in shapehaving a base portion 426 and an apex portion 428. The slots 424 areoppositely-oriented triangularly shaped areas having slot base portions430 extending between two adjacent rib apex portions 428 and slot apexportions 432 separating adjacent rib base portions 426. On the internalwall surface 63 of the plunger chamber 64 are similarly shaped plungerribs 434 and plunger slots 436. The ribs 420 are dimensioned to fitwithin the plunger slots 436 and the slots 424 are dimensioned to fitover and receive the plunger ribs 434. Thus, when the cap holder 402 orthe cap holder assembly 404 is inserted in the plunger chamber 64 thecap holder ribs 420 are interdigitated with the plunger ribs 434 toprevent or resist the relative rotation of the cap holder 402, or capholder assembly 404, with respect to the plunger assembly 12′.

In yet another preferred form of the invention, the cap holder 402, thecap holder assembly 404 or the plunger assembly 12′ will have astructure, element or the like that resists the relative axial movementof these parts when the cap holder 402 or the cap holder assembly 404 ispositioned fully within the plunger assembly 12′. In one preferred formof the invention the cap holder 402 has an annular protuberance 440 thatis dimensioned to fit within an annular groove 442 on the inner wallsurface 414 of the cap holder and preferably extends in line with thebase portions of the plunger ribs 434. A second locking structure isprovided having a plurality of teeth 450 which extend axially outwardfrom the outer wall surface 414 of the cap holder and are positioned inslots 424. In a preferred form of the invention the teeth extend axiallyoutwardly to a height beyond the height of the ribs 434. The teeth 450can be positioned in one or more of the slots or in each of the slots424 or in alternating slots or, as is shown, circumferentially spaced90° from one another. The teeth 450 preferably are positioned at anintermediate portion, between the base and the apex, of a slot 424. Theteeth 450 are dimensioned to fit within a segmented annular groove 452that extends circumferentially about the inner surface 412 crossingthrough the plunger ribs 434 at an intermediate portion, between thebase and the apex, of the plunger ribs 434.

FIGS. 56 a,b,c respectively show the assembly 400 in a ready-for-useposition, docked position, and used position. The assembly 400 is usedin essentially the same fashion as described above with respect to FIGS.3 and 4 except that when the assembly 400 is in the used position thecap holder 402 remains in the plunger assembly 12′.

The syringe barrel and plunger can be fabricated from any materialsuitable for its purpose and includes glass and polymeric material.Suitable polymeric materials include, but are not limited to,homopolymers, copolymers and terpolymers formed from monomers such asolefins, cyclic olefins, amides, esters, and ethers. The polymericmaterial may be a blend of more than one polymeric material and can be amonolayer structure or a multilayer structure. In one preferred form ofthe invention the syringe barrel and the plunger are injection moldedfrom a polypropylene material.

FIGS. 59-61 show a third embodiment 500 of an antiseptic cap equippedsyringe plunger and barrel assembly with the antiseptic cap assembly 80and lid stock 68 removed for clarity. The third embodiment 500 providesfor retrofitting an antiseptic cap assembly 502 to a standard plunger504. The antiseptic cap 502 has a first generally cylindrical outer wall506 having a proximal end 508 and a distal end 510. The proximal end 508is removably or fixedly attached to a button 512 of the plunger 504. Theproximal end has an opening 514 dimensioned to fit about the button 512and has a member for attaching to the button. In one preferred form ofthe invention, the attaching member includes a plurality ofcircumferentially spaced, and axially inwardly directed tabs 516extending from an inner wall surface 518 and the tabs engage a lowersurface of the button 512 to attach the antiseptic cap assembly 502 tothe plunger 504.

The distal end of the antiseptic cap 502 has a top annular flange 520extending radially inwardly from the first cylindrical wall 506 anddefines a generally circular opening 522. A second cylindrical wall 524extends axially downwardly from the top annular flange 520 and iscoaxially disposed within the first cylindrical wall 506. When theantiseptic cap 502 is attached to the plunger button 512 a bottomperipheral edge of the second cylindrical wall 524 will abut a topsurface of the plunger button 512 thereby capturing, by oppositelydirected axially forces, the plunger button 512 between the tabs 516 andthe second cylindrical wall. It is contemplated, however, that a secondset of tabs could be provided spaced axially away from the first set oftabs and the piston button 512 could be trapped between the two sets oftabs. Further, it is contemplated other attaching means could be usedthat are well known in the art and the attaching member shown is merelyexemplary.

The second cylindrical wall 524 defines a chamber as is shown in greaterdetail in FIG. 5 above with the ribs and slots as described for engagingthe antiseptic cap assembly 80 to prevent relative rotational movementand to resist relative axial movement of the parts when the antisepticcap assembly 80 is fully inserted into the chamber. Further, it iscontemplated adapting the plunger and syringe as described above toprevent or resist the relative rotational movement of the plunger withrespect to the barrel.

The piston 50 can be formed from any suitable material including apolymeric material or a silicone material. The stopper can be selectedfrom a material with a desired durometer so that reflux is reduced whenthe stopper engages an inner surface of the distal end wall of thesyringe barrel.

Suitable locking and flush solutions include a lower alcohol selectedfrom ethanol, propanol and butanol. The locking solution can be a singlelower alcohol or a blend of lower alcohols.

Suitable locking solutions can also include a lower alcohol with anantimicrobial and/or an anticoagulant. Suitable locking solutions cancontain at least one lower alcohol in a range from 1% to 99% by volumeand at least one other antimicrobial and/or anti-coagulant compound in arange from 1% to 99% by volume. The lower alcohol will usually be inaqueous solution, typically at 1% to 99% by volume, usually from 5% to95% by volume. The at least one other antimicrobial is selected from thegroup consisting of taurolidine and triclosan, and the at least oneanti-coagulant is selected from the group consisting of riboflavin,sodium citrate, ethylene diamine tetraacetic acid, and citric acid.

In one preferred form of the invention, the syringe assembly 10 will bepre-filled with one of the locking solutions and will be packaged by amanufacture and shipped to a health care provider. A cannula or needlewill be attached to the distal end of the barrel and placed into fluidcommunication with the fluid access site of an indwelling central venouscatheter. The flush solution will be injected into the catheter to cleanor lock the catheter. Afterwards, the cap assembly 80 will be removedfrom the plunger 17 and the cap will be docked to the fluid access siteof the catheter.

Citrate Salt Containing Antiseptic Solutions

In one form, the antiseptic is a solution a citrate salt and in anotherform of the invention the citrate salt solution is a hypertonicsolution. The term hypertonic is used herein to refer to a fluid havingan osmotic concentration and a density greater than the osmoticconcentration and density of the blood of the patient. The antisepticsolution preferably comprises a citrate salt with a concentration range,in weight percent, of from about 1.5% to about 50% with an osmolality ofabout 300 to about 6400 mOsm. More preferably, the antiseptic solutioncomprises citrate salt in a concentration range of from about 10% toabout 40%, yet more preferably, in a concentration range of from about20% to about 30%.

In a preferred embodiment, the antiseptic solution is prepared to have apH lower than that of the pH of the patient's blood. The citrate saltsolution may be prepared to have a pH lower than about 6.5, morepreferably, from about 4.5 to about 6.5. Also, the citrate salt solutioncan include pharmaceutically acceptable agents such as sodium chlorideand sodium heparin. The citrate salt solution can also include a varietyof other antibacterial, antimicrobial and anticoagulant agents such asgentamicin, vancomycin, and mixtures of these agents. Additionalanticoagulant agents include, for example heparin, urokinase, tissueplasminogen activation (tPA) and mixtures of these agents.

By “pharmaceutically acceptable,” it is meant that the citrate saltsolution and the included salts and other additives which are, withinthe scope of sound medical judgment, suitable for use in contact withtissues of humans and lower animals without undue toxicity, irritation,and allergic response. It is also typically necessary that a compositionbe sterilized to reduce the risk of infection.

Antibacterial Agent Containing Antiseptic Solutions

An antimicrobial agent containing antiseptic solution of the presentinvention may contain at least one alcohol, at least one antimicrobialagent and at least one chelator and/or anticoagulant. Variousantimicrobial substances as disclosed herein and that are well known toone of ordinary skill in the art may be combined with the lockingsolution in order to inhibit infection. The antimicrobial lockingsolution of the present invention may be use for filling or flushing amedical device such as an indwelling device such as an implantedcatheter. Other medical devices that are contemplated for use in thepresent invention are disclosed herein.

In another preferred form of the invention, the antiseptic agent cancontain antibacterial agents such as those classified asaminoglycosides, beta lactams, quinolones or fluoroquinolones,macrolides, sulfonamides, sulfamethoxazoles, tetracyclines,streptogramins, oxazolidinones (such as linezolid), clindamycins,lincomycins, rifamycins, glycopeptides, polymyxins, lipopeptideantibiotics, as well as pharmacologically acceptable sodium salts,pharmacologically acceptable calcium salts, pharmacologically acceptablepotassium salts, lipid formulations, derivatives and/or analogs of theabove.

The aminoglycosides are bactericidal antibiotics that bind to the 30Sribosome and inhibit bacterial protein synthesis. They are typicallyactive against aerobic gram-negative bacilli and staphylococci.Exemplary aminoglycosides that may be used in some specific aspects ofthe invention include amikacin, kanamycin, gentamicin, tobramycin, ornetilmicin.

Suitable beta lactams are selected from a class of antibacterials thatinhibit bacterial cell wall synthesis. A majority of the clinicallyuseful beta-lactams belong to either the penicillin group (penam) orcephalosporin (cephem) groups. The beta-lactams also include thecarbapenems (e.g., imipenem), and monobactams (e.g., aztreonam).Inhibitors of beta-lactamase such as clavulanic acid and its derivativesare also included in this category.

Non-limiting examples of the penicillin group of antibiotics that may beused in the solutions of the present invention include amoxicillin,ampicillin, benzathine penicillin G, carbenicillin, cloxacillin,dicloxacillin, piperacillin, or ticarcillin, etc. Examples ofcephalosporins include ceftiofur, ceftiofur sodium, cefazolin, cefaclor,ceftibuten, ceftizoxime, cefoperazone, cefuroxime, cefprozil,ceftazidime, cefotaxime, cefadroxil, cephalexin, cefamandole, cefepime,cefdinir, ceftriaxone, cefixime, cefpodoxime proxetil cephapirin,cefoxitin, cefotetan etc. Other examples of beta lactams includeimipenem or meropenem which are extremely active parenteral antibioticswith a spectrum against almost all gram-positive and gram-negativeorganisms, both aerobic and anaerobic and to which Enterococci, B.fragilis, and P. aeruginosa are particularly susceptible.

Suitable beta lactamase inhibitors include clavulanate, sulbactam, ortazobactam. In some aspects of the present invention, the antibacterialsolutions may comprise a combination of at least one beta lactam and atleast one beta lactamase inhibitor.

Macrolide antibiotics are another class of bacteriostatic agents thatbind to the 50S subunit of ribosomes and inhibit bacterial proteinsynthesis. These drugs are active against aerobic and anaerobicgram-positive cocci, with the exception of enterococci, and againstgram-negative anaerobes. Exemplary macrolides include erythromycin,azithromycin, clarithromycin.

Quinolones and fluoroquinolones typically function by their ability toinhibit the activity of DNA gyrase. Examples include nalidixic acid,cinoxacin, trovafloxacin, ofloxacin, levofloxacin, grepafloxacin,trovafloxacin, sparfloxacin, norfloxacin, ciprofloxacin, moxifloxacinand gatifloxacin.

Sulphonamides are synthetic bacteriostatic antibiotics with a widespectrum against most gram-positive and many gram-negative organisms.These drugs inhibit multiplication of bacteria by acting as competitiveinhibitors of p-aminobenzoic acid in the folic acid metabolism cycle.Examples include mafenide, sulfisoxazole, sulfamethoxazole, andsulfadiazine.

The tetracycline group of antibiotics include tetracycline derivativessuch as tigecycline which is an investigational new drug (IND),minocycline, doxycycline or demeclocycline and analogs such asanhydrotetracycline, chlortetracycline, or epioxytetracycline.

Suitable streptogramin class of antibacterial agents includequinupristin, dalfopristin or the combination of two streptogramins.

Drugs of the rifamycin class typically inhibit DNA-dependent RNApolymerase, leading to suppression of RNA synthesis and have a verybroad spectrum of activity against most gram-positive and gram-negativebacteria including Pseudomonas aeruginosa and Mycobacterium species. Anexemplary rifamycin is rifampicin.

Other antibacterial drugs are glycopeptides such as vancomycin,teicoplanin and derivatives thereof. Yet other antibacterial drugs arethe polymyxins which are exemplified by colistin.

In addition to these several other antibacterial agents such aspristinamycin chloramphenicol, trimethoprim, fusidic acid,metronidazole, bacitracin, spectinomycin, nitrofurantoin, daptomycin orother lipopeptides, oritavancin, dalbavancin, ramoplanin, ketolide etc.may be used in preparing the antiseptic solutions described herein. Ofthese, metronidazole is active only against protozoa, such as Giardialamblia, Entamoeba histolytica and Trichomonas vaginalis, and strictlyanaerobic bacteria. Spectinomycin, is a bacteriostatic antibiotic thatbinds to the 30S subunit of the ribosome, thus inhibiting bacterialprotein synthesis and nitrofurantoin is used orally for the treatment orprophylaxis of UTI as it is active against Escherichia coli,Klebsiella-Enterobacter species, staphylococci, and enterococci.

In other embodiments, the antimicrobial agent is an antifungal agent.Some exemplary classes of antifungal agents include imidazoles ortriazoles such as clotrimazole, miconazole, ketoconazole, econazole,butoconazole, omoconazole, oxiconazole, terconazole, itraconazole,fluconazole, voriconazole, posaconazole, ravuconazole or flutrimazole;the polyene antifungals such as amphotericin B, liposomal amphotericinB, natamycin, nystatin and nystatin lipid formulations; the cell wallactive cyclic lipopeptide antifungals, including the echinocandins suchas caspofungin, micafungin, anidulafungin, cilofungin; LY121019;LY303366; the allylamine group of antifungals such as terbinafine. Yetother non-limiting examples of antifungal agents include naftifine,tolnaftate, mediocidin, candicidin, trichomycin, hamycin, aureofungin,ascosin, ayfattin, azacolutin, trichomycin, levorin, heptamycin,clindamycin, griseofulvin, BF-796, MTCH 24, BTG-137586, pradimicins (MNS18184), benanomicin; ambisome; nikkomycin Z; flucytosine, or perimycin.

In another preferred form of the invention, the antimicrobial agent isan antiviral agent. Non-limiting examples of antiviral agents includecidofovir, amantadine, rimantadine, acyclovir, ganciclovir, penciclovir,famciclovir, foscarnet, ribavirin, or valaciclovir. In some forms of theinvention the antimicrobial agent is an innate immune peptide orproteins. Some exemplary classes of innate peptides or proteins aretransferrins, lactoferrins, defensins, phospholipases, lysozyme,cathelicidins, serprocidins, bactericidal permeability increasingproteins, amphipathic alpha helical peptides, and other syntheticantimicrobial proteins.

In other embodiments of the invention, the antimicrobial agent is anantiseptic agent. Several antiseptic agents are known in the art andthese include a taurinamide derivative, a phenol, a quaternary ammoniumsurfactant, a chlorine-containing agent, a quinaldinium, a lactone, adye, a thiosemicarbazone, a quinone, a carbamate, urea, salicylamide,carbanilide, a guanide, an amidine, an imidazoline biocide, acetic acid,benzoic acid, sorbic acid, propionic acid, boric acid, dehydroaceticacid, sulfurous acid, vanillic acid, esters of p-hydroxybenzoic acid,isopropanol, propylene glycol, benzyl alcohol, chlorobutanol,phenylethyl alcohol, 2-bromo-2-nitropropan-1,3-diol, formaldehyde,glutaraldehyde, calcium hypochlorite, potassium hypochlorite, sodiumhypochlorite, iodine (in various solvents), povidone-iodine,hexamethylenetetramine, noxythiolin, 1-(3-chloroallyl)-3,5,7-triazo1-azoniaadamantane chloride, taurolidine, taurultam,N(5-nitro-2-furfurylidene)-1-amino-hydantoin, 5-nitro-2-furaldehydesemicarbazone, 3,4,4′-trichlorocarbanilide,3,4′,5-tribromosalicylanilide,3-trifluoromethyl-4,4′-dichlorocarbanilide, 8-hydroxyquinoline,1-cyclopropyl-6-fluoro-1,4-dihydro-4-oxo-7-(1-piperazinyl)-3-quinolinecarboxylicacid,1,4-dihydro-1-ethyl-6-fluoro-4-oxo-7-(1-piperazinyl)-3-quinolinecarboxylicacid, hydrogen peroxide, peracetic acid, phenol, sodium oxychlorosene,parachlorometaxylenol, 2,4,4′-trichloro-2′-hydroxydiphenol, thymol,chlorhexidine, benzalkonium chloride, cetylpyridinium chloride, silversulfadiazine, or silver nitrate.

In another preferred form of the invention, the antiseptic solutionincludes a basic reagent and a dye. The basic reagent may be a guanidinecompound, a biguanide, a bipyridine, a phenoxide antiseptic, an alkyloxide, an aryl oxide, a thiol, a halide, an aliphatic amine, or anaromatic amine. In some specific aspects, the basic reagent is aguanidine compound. Non-limiting examples of guanidine compounds includechlorhexidine, alexidine, hexamidine. In other specific embodiments, thebasic reagent is a bipyridine. One example of a bipyridine isoctenidine. In yet other aspects, the basic reagent is a phenoxideantiseptic.

The dye may be a triarylmethane dye, a monoazo dye, a diazo dye, anindigoid dye, a xanthene dye, an anthraquinone dye, a quinoline dye, anFD&C dye. Non-limiting examples of triarylmethane dye include gentianviolet, crystal violet, ethyl violet, or brilliant green. Exemplarymonoazo dyes include FD&C Yellow No. 5, or FD&C Yellow No. 6. Othernon-limiting examples of FD&C dye include Blue No. 1 or Green No. 3. Onenon-limiting example of diazo dyes is D&C Red No. 17. An example of anindigoid dye is FD&C Blue No. 2. An example of a xanthene dye is FD&CRed No. 3; of an anthraquinone dye is D&C Green No. 6; and of anquinoline dye is D&C Yellow No. 1.

Other examples of antiseptics that may be used to the solutions of theinvention are the phenoxide antiseptics such as clofoctol, chloroxylenolor triclosan. Still other antiseptic agents that may be used to preparethe antimicrobial solutions of the invention are gendine, genlenol,genlosan, or genfoctol.

One of skill in the art will appreciate that one can use one or more ofthe antimicrobial agents including one or more antibacterial agent,and/or one or more antifungal agent, and/or one or more antiviral agent,and/or one or more antiseptic agent, and/or combinations thereof.

A wide variety of chelator agents are contemplated as useful inpreparing the antiseptic solutions of the invention. This includeschelators such as EDTA free acid, EDTA 2Na, EDTA 3Na, EDTA 4Na, EDTA 2K,EDTA 2Li, EDTA 2NH₄, EDTA 3K, Ba(II)-EDTA, Ca(II)-EDTA,Co(II)-EDTACu(II)-EDTA, Dy(III)-EDTA, Eu(III)-EDTA, Fe(III)-EDTA,In(III-EDTA, La(III)-EDTA, CyDTA, DHEG, diethylenetriamine penta aceticacid (DTPA), DTPA-OH, EDDA, EDDP, EDDPO, EDTA-OH, EDTPO, EGTA, HBED,HDTA, HIDA, IDA, MethylEDTA, NTA, NTP, NTPO, O-Bistren, TTHA, EGTA,DMSA, deferoxamine, dimercaprol, zinc citrate, a combination of bismuthand citrate, penicillamine, succimer or Etidronate. It is contemplatedthat any chelator which binds barium, calcium, cerium, cobalt, copper,iron, magnesium, manganese, nickel, strontium, or zinc will beacceptable for use in the present invention.

Co(II)-EDTACu(II)-EDTA, Dy(III)-EDTA, Eu(III)-EDTA, Fe(III)-EDTA,In(III)-EDTA, La(III)-EDTA, CyDTA, DHEG, diethylenetriamine penta aceticacid (DTPA), DTPA-OH, EDDA, EDDP, EDDPO, EDTA-OH, EDTPO, EGTA, HBED,HDTA, HIDA, IDA, MethylEDTA, NTA, NTP, NTPO, O-Bistren, TTHA, EGTA,DMSA, deferoxamine, dimercaprol, zinc citrate, a combination of bismuthand citrate, penicillamine, succimer or Etidronate. It is contemplatedthat any chelator which binds barium, calcium, cerium, cobalt, copper,iron, magnesium, manganese, nickel, strontium, or zinc will beacceptable for use in the present invention.

Alternatively, one may use at least one anticoagulant such as heparin,hirudin, EGTA, EDTA, urokinase, streptokinase, hydrogen peroxide etc.,in the preparation of the antimicrobial solutions of the invention.

In addition to the alcohols set forth above, a variety of alcohols arecontemplated as useful in the preparation of the instant antisepticsolution, and include any antimicrobially active alcohol. Non-limitingexamples of alcohols include ethanol, methanol, isopropanol, propyleneglycol, benzyl alcohol, chlorobutanol, phenylethyl alcohol, and thelike.

One of skill in the art will appreciate that the solutions of theinstant invention can comprise various combinations of at least onealcohol, at least one antimicrobial agent, and at least onechelator/anticoagulant. In some specific embodiments, the solution ofthe invention comprises at least one alcohol, at least one tetracyclineand at least one chelator/anticoagulant. In a specific aspect, such anantimicrobial solution comprises ethanol, at least one tetracycline andEDTA or heparin.

In other specific aspects, such a solution comprises ethanol,minocycline and EDTA or heparin. In one embodiment of this aspect, theconcentration of minocycline is 0.001 mg/ml to 100 mg/ml. In anotherembodiment, the concentration of minocycline is about 3 mg/ml. Inanother aspect, the concentration of EDTA is in the range of 10-100mg/ml. In one embodiment of this aspect, the concentration of EDTA isabout 30 mg/ml.

In another preferred form of the invention, the antiseptic solutionincludes a pharmacologically acceptable sodium salt, a pharmacologicallyacceptable calcium salt, a pharmacologically acceptable potassium saltand about one milligram per milliliter polyhexamethylene biguanidehydrochloride in an aqueous admixture. Additionally, the solution of theinvention may also contain a pharmacologically acceptable salt of lacticacid.

Salt Containing Antiseptic Solutions

One preferred antiseptic solution includes a pharmacologicallyacceptable sodium salt such as sodium chloride or the like in aconcentration of between about 820 mg to about 900 mg, apharmacologically acceptable calcium salt, such as calcium chloridedihydrate or the like in a concentration between about 30.0 mg to about36.0 mg, a pharmacologically acceptable potassium salt, such aspotassium chloride or the like in a concentration between about 28.5 toabout 31.5 mg and about one milligram per milliliter polyhexamethylenebiguanide hydrochloride in an aqueous admixture with one hundredmilliliters of water for injection U.S.P. For particular applications,the solution of the invention may also include sodium lactate in aconcentration between about 290 mg and about 330 mg in the one hundredmilliliter aqueous admixture.

Photo-Oxidant Solutions

In another preferred form of the present invention, the antisepticsolution contains an anticoagulant and a photo-oxidant. In certainembodiments, a photo-oxidant is selected that has an antiseptic effect.As used herein, the term “photo-oxidant” is intended to refer to acompound (usually an organic dye) that has photo-oxidation properties,in which the compound exhibits an increased oxidizing potential uponexposure to radiant energy such as light. The term “photooxidant” alsorefers to a composition that releases one or more electrons when struckby light.

In one preferred aspect of the invention, the photo-oxidant is methyleneblue, which advantageously provides antibiotic and antifungal activity,and also provides a color to make the antiseptic solution clearlyidentifiable. In addition to methylene blue, other photo-oxidants mayinclude Rose Bengal, hypericin, methylene violet, proflavine, rivanol,acriflavine, toluide blue, trypan blue, neutral red, a variety of otherdyes or mixtures thereof. Therefore, in alternate aspects of theinvention, one or more alternative photo-oxidants, preferably a coloredphoto-oxidant is used in accordance with the invention in place ofmethylene blue.

Enhanced Viscosity Solutions

In another preferred form of the invention, the antiseptic solutionincludes a low viscosity antibacterial agent mixed with a viscosityincreasing agent. Examples of antibacterial agents which may be used, inaddition to those described above, comprise alcohols, chlorhexidine,Clorpactin, iodine, tauroline, citric acid, and soluble citric acidsalts, particularly sodium citrate, optionally mixed with water.

Suitable viscosity increasing agents include Carbopol, starch,methylcellulose, carboxypolymethylene, carboxymethyl cellulose,hydroxypropylcellulose, or the like. Carbopol is a cross-linkedpolyacrylic acid based polymer sold by Noveon, Inc. It is preferablyneutralized to about pH 7 with a base material such astetrahydroxypropyl ethylene diamine, triethanolamine, or sodiumhydroxide. Derivatives of starch may also be used, such ashydroxyethylstarch, hydroxypropylstarch, or starch having bonded organicacid ester groups, to improve compatibility with antibacterial agentssuch as alcohols, for example, ethanol or isopropanol. Such ester groupsmay be the reaction product of two to twelve carbon organic acids withthe starch, for example. Also, the elevated viscosity antisepticsolution may be created by the use of a fat emulsion, or otherdispersions in water/alcohol of glycerol mono or di esters of fattyacids, or fatty acid esters of other polyols such as sugars having oneor more bonded fatty acid groups per molecule. Analogous compounds withether linkages may also be used.

Also, other materials such as alginic acid, with or without calciumcitrate may be used, or polyvinyl alcohol, with or without borax,povidone, polyethylene glycol alginate, sodium alginate, and/ortragacanth. If desired, the fluid of this invention may also contain aneffective amount of an antithrombogenic agent such as heparin, and adiluent such as water, along with other desired ingredients.

In one preferred form of the invention, the antiseptic solution containsa mixture of isopropyl alcohol and neutralized Carbopol, with otheroptional ingredients being present such as water, antithrombogenicagents such as heparin, and the like. Preferably, about 0.4 to 2 weightpercent of Carbopol is present. Citric acid may also be present as anantibacterial agent, either with or as a substitute for anotheranti-bacterial agent such as isopropyl alcohol or ethanol.

In another embodiment, the antiseptic solution is a gel of an isopropylalcohol, optionally with up to about 30 weight percent water, and about2.2 weight percent hydroxypropylcellulose, to form a high viscosityantiseptic solution.

In yet another preferred form of the invention, the antiseptic solutioncontains carbohydrates and/or glucose degradation products. Suitablecarbohydrates are chosen form the group of glucose and/or fructose.Suitable degradation products include 3-deoxyglucosone (3-DG),acetaldehyde, formaldehyde, acetaldehyde, glyoxal, methylglyoxal;5-hydroxymethyl-2-furaldehyde (5-HMF), 2-furaldehyde, and3,4-dideoxyglucosone-3-ene (3,4-DGE).

Other suitable agents to be used in this embodiment of the antisepticsolution includes substances having anticoagulatory properties i.e.,inhibitors of the coagulation cascade such as heparin of standard andlow molecular weight, fractionated heparin, synthetic inhibitors in thecoagulation cascade, Futhan as a broad protease inhibitor, complexingand chelating substances such as citrate, EDTA, EGTA, substances andmixtures used for preservation of blood products (platelets or plasma),CDPA (citrate, sodium phosphate, dextrose, adenine), synthetic ornatural thrombin inhibitor substances. Other suitable additives includefucoidan, riboflavin, vitamin E, alphatocopherol, folic acid and aminoacids. Furthermore, antiinflammatory compounds and drugs could also beused, e.g. cortison, mycophenolic acid (MPA) and derivatives thereof,sirolimus, tacrolimus and cyclosporin, diclofenac, etc.

Inhibitory peptides can also be used in the antiseptic solution such asdefensins, (dermcidin), and others. Radicals, such as reactive oxygenspecies, NO-releasing systems or nitric oxide (NO), and peroxynitritemay also be used. A buffer composition may also be included in theantiseptic solution, and in one preferred form of the invention, thebuffer contains lactate, bicarbonate, pyruvate, ethyl pyruvate andcitric acid in combination and mixtures including adjustment of pH byacetic acid, hydrochloric acid or sulphuric acid. Furthermore, viscosityenhancing additives may be added, such as lipids or lipidic substances(also to get water insoluble vitamins or complexes into solution),nutrients in high concentration density gradient e.g. amino acidcontaining fluids, polyglucose, icodextrin, pectin, hydroxyethyl starch(HES), alginate, hyaluronic acid, etc.

Taurolidine Antiseptic Solutions and Gels

The antiseptic solutions of the present invention can includeTaurolidine and/or Taurultam to prevent clotting and Biofilm formationor the elements can be combined with other antimicrobial agents. Oneembodiment of the present invention is a gel with thixotropic propertiesto keep the solution inside the antiseptic cap and not spill out duringthe time interval between uses. This is accomplished by making ahydrogel matrix as a drug delivery vehicle containing a biocompatibleantimicrobial agent alone or with another active agent, which may beuseful for particular purposes. The hydrogel matrix is biocompatibleand, biodegradable in the bloodstream. The matrix can be a hydrogel(e.g., pectin, gelatin, etc), a protein (e.g., collagen, hemoglobin,etc), a colloidal substance (e.g., serum albumin etc.), an emulsion orother adjuvant. Preferably, the matrix shall have structural integrityand be thixotropic. Thixotropy is a property, which is exhibited bycertain gels. It is a property characterized by a solid or semisolidsubstance that when shaken, stirred or subject to high shear forcesbecomes fluid like and can flow and then returns to the semisolid statewhen the forces and/movement are stopped. Alternatively, the gel couldhave the properties similar to that of the colloidal dispersion whichresists movement, or flow until a high shear force is imparted to thefluid and then it flows easily.

Other ingredients may be added to the gel matrix to provide furtherfunctional benefit. The preferred antimicrobial is Taurolidine, whichcan be added to the matrix as a micro particle powder, or encapsulatedin liposomes, microspheres, or nanospheres. It should be appreciatedthat numerous active agents and drugs can be added to the thixotropicgel including sterilants, lysing agents (such as Urokinase), imagingenhancers, catheter surface modifiers, antibiotics and antimicrobialchemicals.

A hydrogel comprises a three-dimensional molecular network containinglarge quantities of water giving them good biocompatibility withmaterial consistency that is soft solid-like with high diffusiveproperties to gases, chemicals and proteins. Suitable hydrogels includenatural polymers including serum albumin, collagen, or alginates,polyvinyl alcohol, poly (ethylene oxide) or poly (hydroxyethylene) andpolyelectrolytes, such as poly(acrylic acid), poly(styrene sulfonate),and carboxymethylcellulose (CMC).

One preferred form of the antiseptic solution includes Taurolidine withSalicylic acid or Sodium Salicylate in an aqueous solvent. SalicylicAcid and Sodium Salicylate are drugs that have been used with antibioticlocks in catheters to enhance the biocidal action of the antibioticalone and to inhibit the attachment of microbes to surfaces. This lastattribute is especially important because the initiation of a Biofilmexpression and growth require that the individual bacteria must firstattach themselves to the underlying surface. By stopping attachment,Biofilm formation is blocked.

Sodium salicylate has been demonstrated to have remarkable antibacterialactivity, including the ability to enhance the activities of certainantibiotics. This drug inhibits adherence, growth and Biofilm formation.

EDTA Containing Antiseptic Solutions

In one preferred antiseptic solution of the present invention providesantimicrobial, antifungal, anti-viral and anti-amoebic properties andmay also serve as an anti-coagulant. Specified salts and compositions ofethylene diamine tetraacetic acid (EDTA) (C₁₀H₁₂N₂Na₄O₈) are used atspecified concentrations and pH levels.

The EDTA formulations of the present invention are safe for humanadministration and are biocompatible and non-corrosive. They may alsohave anticoagulant properties and are thus useful for preventing and/ortreating a variety of catheter-related infections. In one embodiment,antiseptic solutions of the present invention have at least four, andpreferably at least five, of the following properties: anticoagulantproperties; inhibitory and/or bactericidal activity against a broadspectrum of bacteria in a planktonic form; inhibitory and/or fungicidalactivity against a spectrum of fungal pathogens; inhibitory and/orbactericidal activity against a broad spectrum of bacteria in a sessileform; inhibitory activity against protozoan infections; inhibitoryactivity against Acanthamoeba infections; safe and biocompatible, atleast in modest volumes, in contact with a patient; safe andbiocompatible, at least in modest volumes, in a patient's bloodstream;and safe and compatible with industrial objects and surfaces. Theantiseptic solution can have a pH higher than physiological pH such as apH of >8.0, or at a pH>8.5, or at a pH>9, or at a pH>9.5.

In another preferred form of the invention, the antiseptic solutioncontain a sodium EDTA salt (or combination of sodium salts) in solutionat a pH in the range between 8.5 and 12.5 and, in another embodiment, ata pH of between 9.5 and 11.5 and, in yet another embodiment, at a pH ofbetween 10.5 and 11.5.

When used herein, the term “EDTA salt” may refer to a single salt, suchas a di-sodium or tri-sodium or tetra-sodium salt, or another EDTA saltform, or it may refer to a combination of such salts. The composition ofEDTA salt(s) depends both on the EDTA salts used to formulate thecomposition, and on the pH of the composition. For antiseptic solutionsof the present invention consisting of sodium EDTA salt(s), and at thedesired pH ranges (specified above), the sodium EDTA salts arepredominantly present in both the tri-sodium and tetra-sodium saltforms.

In one embodiment, the antiseptic solution contains a combination of atleast the tri-sodium and tetra-sodium salts of EDTA, and more preferablysolutions containing at least 10% of the EDTA in the composition ispresent in the tetra-sodium salt form. In yet another embodiment, atleast 50% and, more preferably at least 60%, of the EDTA in thecomposition is present in the tri-sodium salt form.

EDTA solutions of the present invention are preferably provided in asterile and non-pyrogenic form and may be packaged in any convenientfashion. The compositions may be prepared under sterile, asepticconditions, or they may be sterilized following preparation and/orpackaging using any of a variety of suitable sterilization techniques.

Formulation and production of antiseptic compositions of the presentinvention is generally straightforward. In one embodiment, desiredantiseptic solutions of the present invention are formulated bydissolving one or more EDTA salt(s) in an aqueous solvent, such aspurified water, to the desired concentration and adjusting the pH of theEDTA salt solution to the desired pH. The antiseptic solution may thenbe sterilized using conventional means, such as autoclaving, UVirradiation, filtration and/or ultrafiltration, and other means. Thepreferred osmolarity range for EDTA solutions is from 240-500 mOsM/Kg,more preferably from 300-420 mOsM/Kg. The solutions are preferablyformulated using USP materials.

Antiseptic solutions containing sodium salts of EDTA other than tri- andtetra-sodium salts, such as di-sodium EDTA, is also contemplated. Forexample di-sodium EDTA solutions can be used but such solutions have alower pH in solution than the desired pH range of compositions of thepresent invention but, upon pH adjustment to the desired range using apH adjustment material, such as sodium hydroxide, sodium acetate, andother well-known pH adjustment agents, EDTA solutions prepared usingdi-sodium salts are converted to the preferred combination di- and/ortri- and/or tetra-sodium salt EDTA solutions of the present invention.Thus, different forms and combinations of EDTA salts may be used in thepreparation of EDTA compositions of the present invention, provided thatthe pH of the composition is adjusted to the desired pH range prior touse. In one embodiment, antiseptic compositions consisting of a mixtureof primarily tri- and tetra-sodium EDTA is provided by dissolvingdi-sodium EDTA in an aqueous solution, 3%-5% on a weight/volume basis,and adding sodium hydroxide in a volume and/or concentration sufficientto provide the desired pH of >8.5 and <12.0.

Antibacterial Enzyme Containing Antiseptic Solutions

“Antibacterial enzyme” refers to any proteolytic, pore-forming,degradative or inhibitory enzyme that kills or damages a bacterialspecies or particular strain thereof. The result may be achieved bydamaging the cell wall of the bacteria, disrupting cell membranesassociated with the cell wall or within the bacteria, inhibiting proteinsynthesis within the bacteria, disrupting the sugar backbone, or by anyother mechanism attributed to a peptide or protein considered by thoseskilled in the art to be an antibacterial enzyme. The enzyme may be anatural, wild-type enzyme, modified by conventional techniques,conjugated to other molecules, recombinantly expressed, or syntheticallyconstructed.

One example of an antibacterial enzyme is lysostaphin. Lysostaphin isimportant because it is effective in the treatment of staphylococci andbiofilms formed therefrom. “Lysostaphin,” and “lysostaphin analogues”are defined as including lysostaphin (wild type), any lysostaphin mutantor variant, any recombinant, or related enzyme (analogue) or anysynthetic version or fragment of lysostaphin (whether synthetic orotherwise) that retains the proteolytic ability, in vivo and in vitro,to cleave the cross-linked polyglycine bridges in the cell wallpeptidoglycan of staphylococci. The enzymes may be generated bypost-translational processing of the protein (either by enzymes presentin a producer strain or by means of enzymes or reagents introduced atany stage of the process) or by mutation of the structural gene.Mutations may include site deletion, insertion, domain removal andreplacement mutations.

The lysostaphin may be synthetically constructed, expressed in mammaliancells, insects, bacteria, yeast, reptiles or fungi, recombinantlyexpressed from a cell culture or higher recombinant species such as amouse, or otherwise. This would include the activity-retaining syntheticconstruction including synthetic peptides and polypeptides orrecombinant expression of portions of the lysostaphin enzyme responsiblefor its activity against staphylococci as part of a larger protein orpeptide, include chimeric proteins, containing the active sites of oneor more other antibacterial enzymes that are effective either againststaphylococci or other biofilm forming bacteria species.

The antibacterial enzymes may also be coated on the surface of thedevices described herein by immersion of the device in a solution of theenzyme for a length of time sufficient to form a biofilm-formationinhibiting coating of the enzyme on the susceptible surface. Even themost minimal concentration of enzyme will confer some protection.Typically, a concentration of from about 10 μg/ml to about 100 mg/ml canbe used. With device surfaces, the coatings may also be formed bycovalent attachment of the enzyme thereto.

Antiseptic Coatings

It is contemplated that the devices described herein can be coated withan antiseptic coating by any suitable technique such as immersion of thepart into an antiseptic solution, by spray coating the part with theantiseptic solution, by blending the antiseptic solution or materialinto the polymeric material used to fabricate the device.

In one preferred form of the invention, a quantity of physiological,antimicrobial metal compound is added to the resin for direct molding ofan article. Physiological, antimicrobial metals are meant to include theprecious metals, such as silver, gold and platinum, and copper and zinc.Physiological, antimicrobial metal compounds used herein include oxidesand salts of preferably silver and also gold, for example: silveracetate, silver benzoate, silver carbonate, silver citrate, silverchloride, silver iodide, silver nitrate, silver oxide, silversulfadiazine, silver sulfate, gold chloride and gold oxide. Platinumcompounds such as chloroplatinic acid or its salts (e.g., sodium andcalcium chloroplatinate) may also be used. Also, compounds of copper andzinc may be used, for example: oxides and salts of copper and zinc suchas those indicated above for silver. Single physiological, antimicrobialmetal compounds or combinations of physiological, antimicrobial metalcompounds may be used.

Preferred physiological, antimicrobial metal compounds used in thisinvention are silver acetate, silver oxide, silver sulfate, goldchloride and a combination of silver oxide and gold chloride. Theparticles of the silver compounds are sufficiently able to be extractedto form a zone of inhibition to prevent and kill bacteria growth.

In another preferred form of the invention the devices herein areimpregnated with triclosan and silver compounds or triclosan andchlorhexidine.

Referring to FIGS. 62 and 63 , a syringe having a tip cap with anantiseptic cap disposed thereon is generally indicated at 610. Thisarrangement facilitates use of the antiseptic cap by providing the capin a convenient location at the proper time it can be used. The syringe612 includes a barrel 614 having a forward end 616. The forward end ofthe syringe 612 is configured with an access point connection 618 forattachment to an access point to deliver a fluid or medicament to apatient. Prior to use, the syringe access point connection 618 iscovered with a tip cap 620. The tip cap 620 has a proximal end 621 thatis attached to the access point connection of the syringe 612. The tipcap 620 also has a distal end 641 that carries an antiseptic cap 82. Theantiseptic cap 82 could contain an absorbent material such as a sponge86. The sponge 86 could be made from bonded fiber such as the bondedfiber material which is available from Filtrona Porous Technologies,based in Richmond, Va. The sponge 86 can store an antiseptic liquid.

As can be seen in FIGS. 62 and 63 , a cap assembly 680 is sealed by acover or film 650 which is attached to the surface of the tip cap 620such as to a flange 648. A pull tab 652 may be provided for facilitatingremoval of the film 650 to provide access to the antiseptic cap 82.

Referring to FIG. 63 , it can be seen that the tip cap 620 has proximaland distal chambers 622 and 642 respectively, positioned within acylindrical or tapered side wall 624. The side wall 624 is shown to becontinuous but it could have discrete areas of different sizes toaccommodate chambers of different sizes. The side wall 624 could includeribs or gripping surfaces to facilitate handling thereof. The proximalchamber 622 is configured for attachment to the access point connection618 on the forward end 616 of the barrel 614 of the syringe 612 as isknown. As shown, the proximal chamber 622 of the tip cap 620 receivesand releasably engages the central male extension of the access pointconnection 618, as well as the annular surface that extends thereabout.The configuration of the proximal chamber 622 can be varied inaccordance with what is known in the art. The proximal chamber 622 couldhave a base wall 626.

The distal chamber 642 is sized and configured to receive an antisepticcap 82. The distal chamber 642 could have a base wall 646. As with theplunger equipped antiseptic cap previously described, the antiseptic cap82 could have one or more ribs 643 as shown in FIG. 64 , and the innerwall of the distal chamber 642 could have corresponding ribs 645 toprevent relative rotational movement between the distal chamber 642 andthe antiseptic cap 82.

In use, a syringe with an antiseptic cap 82 is provided with a fluid ormedicament for delivery to a patient through an access point. The tipcap 620 is removed from the syringe 612 and the syringe 612 is connectedto the access point and actuated to deliver the fluid or medicament. Thesyringe 612 is then disconnected from the access point, the tip cap 620is accessed, and the pull tab 652 is used to remove the cover 650 toprovide access to the antiseptic cap 82. Then, gripping the tip cap 620,one places the antiseptic cap 82 on the access point and pushes and/ortwists the antiseptic cap 82 onto the access point. Once the antisepticcap 82 is attached to the access point, the tip cap 620 can be removedsuch that the antiseptic cap 82 is withdrawn from the distal chamber 642and remains attached to the access point where it disinfects andprotects the access point until the next time the access point isaccessed.

FIG. 65 shows another aspect of a tip cap 720 wherein a distal chamber742 is configured to receive a cap holder assembly 780 having anantiseptic cap. The tip cap 720 has a proximal end 721 and a distal end741. In this aspect, the distal chamber 742 is configured in accordancewith the configuration of the chamber of the plunger equipped antisepticcap previously described and receives the cap holder assembly 780therein. The antiseptic cap can be used as discussed previously, or thecap holder assembly 780 can be removed from the tip cap 720 and useddirectly.

FIG. 66 shows another aspect of a tip cap 820 wherein a distal chamber842 is configured to receive a cap holder assembly 880 having anantiseptic cap. The tip cap 820 has a proximal section 821 and a distalsection 841. As illustrated, the proximal section 821 and the distalsection 841 can be two discrete sections of varying shape and size. Forexample, the proximal section 821 could have a cylindrical or taperedside wall, as shown. The discrete sections of varying shape or size canaccommodate chambers of different sizes. Further, the discrete sections,e.g., the proximal section 821 and the distal section 841, could includeribs 843 or gripping surfaces to facilitate handling thereof. In thisaspect, the tip cap 820 is configured to change geometry from theproximal section 821 to the distal section 841. Specifically, theproximal section 821 is shown to have a truncated conical shape andconfigured to attach to the access point connection 618 of a syringe612, while the distal section 841 is designed and configured to receivethe cap holder assembly 880. The cap holder assembly 880 may have ribs845 that coact with ribs 843 on the distal chamber 842 to preventrotation of the cap holder assembly 880 with respect to the tip cap 820.The antiseptic cap can be used as discussed previously, or the capholder assembly 880 can be removed from the tip cap 820 and useddirectly.

FIG. 67A is a cross-sectional view showing a syringe with an antisepticcap assembly 980 a disposed thereon generally indicated at 910. Thesyringe 912 includes a barrel 914 having a forward end 916. The forwardend 916 of the syringe 912 is configured with an access point connection918 and a cylindrical wall 919 for attachment to an access point todeliver a fluid or medicament to a patient. Prior to use, the syringeaccess point connection 918 is covered with a cap assembly 980 a thatengages the cylindrical wall 919. The cap assembly 980 a includes anantiseptic cap 982 a and a flexible ring 984 a. The flexible ring 984 acould be formed by an extension of the outer surface 983 of the capassembly 980 or, the flexible ring 984 a could be in the form of aflexible cap having a top 985 b and a circular ring 987 b with a capassembly 980 b attached to the top 985 b, as shown in FIG. 67B. The capassembly 980 is attached to the cylindrical wall 919 of the syringe 612by stretching the flexible ring 984 around the cylindrical wall 919 suchthat the flexible ring 984 forms around and engages the cylindrical wall919. The flexible ring 984 is biased towards a normal diameter that issmaller than, or equal to, the diameter of the cylindrical wall 919,such that the cap assembly 980 is secured to the syringe 912.

FIG. 68 is a side view showing a syringe with an antiseptic cap assemblyattached to a tip cap disposed thereon generally indicated at 1010. Thesyringe 1012 includes a barrel 1014 having a forward end 1016. Theforward end 1016 of the syringe 1012 is configured with an access pointconnection for attachment to an access point to deliver a fluid ormedicament to a patient. Prior to use, the syringe access pointconnection is covered with a tip cap 1020. The tip cap 1020 has aproximal end 1021 that is attached to the access point connection of thesyringe 1012. The tip cap 1020 also has a distal end 1041 comprising asnap-fit flange 1042. A cap holder assembly 1080 carries an antisepticcap 1082 and includes a snap-fit chamber 1084 located at a bottomthereof. The snap-fit chamber 1084 is configured to mate with thesnap-fit flange 1042. In use, the antiseptic cap 1082 could be appliedwhile the antiseptic cap holder assembly 1080 is attached to the tip cap1020 or the antiseptic cap holder assembly 1080 can be removed from thetip cap 1020 and used separately.

Referring to FIGS. 69-72 , a tip cap and cap holder assembly combinationare generally indicated at 1110. The tip cap 1120 has a proximal end1121 that is attached to the access point connection of a syringe and adistal end 1141 comprising a distal end wall 1149 having a distallocking chamber 1142 disposed therein. A cap holder assembly 1180 has aproximal end 1181. The proximal end 1181 of the cap holder assembly 1180includes a locking protrusion 1160 comprising a stem 1162 and a lockingflange 1164, discussed in greater detail below.

Referring to FIGS. 71 and 72 , it can be seen that the tip cap 1120includes a proximal chamber 1122 and the distal locking chamber 1142positioned within a cylindrical or tapered side wall 1124. The side wall1124 could include ribs or gripping surfaces to facilitate handlingthereof. The proximal chamber 1122 is configured for attachment to anaccess point connection on a forward end of a barrel of a syringe as isknown. The configuration of the proximal chamber 1122 can be varied inaccordance with what is known in the art.

The distal locking chamber 1142 comprises a circular chamber having anoblong or oval entrance 1154. The locking flange 1164 on the lockingprotrusion 1160 of the cap holder assembly 1180 has an oblong or ovalshape configured to match the shape of the entrance 1154 of the distallocking chamber 1142. The stem 1162 preferably has a wall thickness thatmatches the distal end wall 1149 of the tip cap 1120. This configurationallows the locking flange 1164 to be inserted into the distal lockingchamber 1142. After the locking flange 1164 is inserted into the distallocking chamber 1142, the cap holder assembly 1180 can be rotated, suchas by 90 degrees, such that the locking flange 1164 rotates in thecircular distal locking chamber 1142, to retain the locking flange 1164in the chamber 1142 such that the locking flange 1164 cannot be pulledtherefrom because of the oblong or oval entrance 1154. In such anarrangement, the cap holder assembly 1180 is locked to the tip cap 1120until it is rotated an additional 90 degrees. Importantly, other lockingflange 1164 and entrance or cutout 1154 geometries are contemplated, andthey are not limited to solely oblong or oval geometries. Instead, thelocking flange 1164 and the entrance or cutout 1154 may be matchingasymmetrical designs, rectangular, triangular, or any other geometricarrangement. In use, the antiseptic cap 1182 could be applied while theantiseptic cap holder assembly 1180 is attached to the tip cap 1120 orthe antiseptic cap holder assembly 1180 can be removed from the tip cap1120 and used separately.

Referring to FIGS. 73-76 , a syringe assembly having a plungerconfigured for removably receiving an antiseptic cap is shown generallyat 1210. As shown in FIGS. 73 and 74 , the syringe 1210 has a barrel1214 and a plunger 1240. The plunger 1240 has a proximal end 1242 thatincludes a chamber 1260, sized to receive and removably hold a capholder assembly 1220. Referring to FIG. 74 , the chamber 1260 is definedby a bottom wall 1261, and an annular sidewall 1262 that has aperipheral proximal end 1266 that defines an opening 1268 through whichthe cap holder assembly 1220 can be inserted into the chamber 1260.

The cap holder assembly 1220, as previously discussed herein, comprisesa cap holder 1222, an antiseptic cap 1282, a sponge 1286 in some cases,an antiseptic material, and a cover or film 1250. A pull tab 1252 couldbe provided for facilitating removal of the film 1250 from the capholder 1222 to provide access to the antiseptic cap 1282. The cap holder1222 could have a distal end 1224 and one or more bulges 1228 on theouter surface 1226 to secure the cap holder assembly 1220 in the chamber1260.

The sidewall 1262 of the plunger 1240 includes one or more apertures1270 defined by edges 1272. The one or more apertures 1270 provideaccess to the chamber 1260 and facilitate removal of the cap holderassembly 1220 from the plunger 1240 as will be described hereinafter.

The cap holder assembly 1220 can be removed from the plunger 1240 andthe process thereof is shown in FIGS. 75 and 76 . As shown in FIG. 75 ,removal of the cap holder assembly 1220 from the plunger 1240 involvesplacing one's thumb or finger through the one or more apertures 1270against a lower surface of the cap holder assembly 1220. As shown inFIG. 76 , one thereafter pushes against the cap holder assembly 1220with a finger or thumb to urge the cap holder assembly 1220 out of thechamber 1260. Ultimately, the cap holder assembly 1220 is ejected fromthe chamber 1260. In this way, the antiseptic cap 1282 could beconveniently used at a different time than the syringe 1210.

FIGS. 77-80 show another embodiment of a chamber 1360 of a plunger 1340wherein an interior surface 1374 of the chamber 1360 of the plunger 1340could have a plurality of circumferentially spaced ribs 1376 thatcontact the cap holder assembly 1320 to secure the cap holder assembly1320 in the chamber 1360. As shown in FIGS. 77-80 , the ribs 1376 couldeach contain a first groove 1378 shaped to accept the bulge 1328 of thecap holder 1322 to further secure the cap holder assembly 1320 withinthe chamber 1360. As such, applying pressure to the cap holder assembly1320, disengages the bulge 1328 from the groove 1378, as shown in FIG.80 . Further pressure against the cap holder assembly 1320 continues theremoval process. The ribs 1376 could also be tapered to facilitate thecontrolled removal of the cap holder assembly 1320, and prevent the capholder assembly 1320 from ejecting too rapidly. The ribs 1376 canprovide a decreasing amount of resistance against the bulge 1328 of thecap holder 1322 as the cap holder assembly 1320 is urged out of thechamber 1360.

FIGS. 81-83 show another embodiment of a chamber 1460 of a plunger 1440.Like the chamber 1360 of the plunger 1340, the chamber 1460 includes aplurality of ribs 1476. In this embodiment the ribs 1476 of the chamber1460 could each contain a first groove 1478 and a shallower secondgroove 1480 closer to the proximal end 1466 of the chamber 1460 andshaped to accept the bulge 1428 of the cap holder 1422 of the cap holderassembly 1420. As shown in FIGS. 82 and 83 , as the cap holder assembly1420 is urged out of the chamber 1460, the bulge 1428 disengages thefirst groove 1478, and then, after continued pressure, engages thesecond groove 1480, and then is removed entirely. The second groove 1480facilitates the controlled ejectment of the cap holder assembly 1420from the chamber 1460 because less force is required to disengage thecap holder assembly 1420 from the second groove 1480 than from the firstgroove 1478.

FIG. 84 is a perspective view showing a plunger 1540 having four supportwalls 1530 extending at 90 degree angles with respect to each other froma common point. Towards the proximal end 1542 of the plunger 1540, oneor more support walls 1530 has a recessed area 1532 proximal the one ormore apertures 1570 to facilitate removal of the cap holder assembly byproviding more clearance for a user to place his or her thumb beneaththe cap holder assembly as previously shown in FIGS. 75 and 76 . Theoutermost edge of the recessed area 1532 is closer to the common pointthan the outermost edge of the rest of the sidewall 1530. The recessedarea 1523 could be defined by a flat edge 1532 a, sloped edge 1532 b, orboth, as shown in FIG. 84 .

FIG. 85 shows a plunger 1640 having a first set of four support walls1630 at 90 degrees with respect to each other positioned at a distalportion of the plunger, and a second set of four support walls 1634 at aproximal portion 1642, some of which are spaced apart at a greater anglewith respect to each other to allow a wider aperture 1670 in thesidewall 1662 of the chamber 1660. At least two of the support wallsflank the aperture of the chamber, which facilitates access to, andremoval of, the cap holder assembly by providing more clearance for auser's finger or thumb or other removal tool, if any.

Shown in FIGS. 86 and 87 is a syringe having a gripping flange 1715 withone or more storage receptacles. Specifically, the gripping flange 1715of the syringe 1710 includes one or more fully or partially boundedapertures 1717 capable of receiving and holding a cap holder assembly1720 and/or a pre-cleaner 1721. The pre-cleaner 1721 could be used wherean access site was not previously disinfected by an antiseptic cap ofthe present invention, if at all. In such a circumstance, thepre-cleaner 1721 would disinfect the access site, the access site wouldbe used, and then the antiseptic cap would be applied. The cap holderassembly 1720 can be attached within the aperture by a friction fit andthe flange about the cap opening can contact the syringe gripping flange1715, or the cap holder assembly could be otherwise engaged within theaperture.

Referring to FIGS. 88-95 , flange connector panels for receiving a capholder assembly can be attached to standard gripping flanges ofsyringes. As shown in FIGS. 88 and 89 , a flange connector panel 1846could have an aperture capable of receiving and holding a cap holderassembly. As shown, the aperture 1817 could have a portion along theouter edge of the flange connector panel 1846 that is unbounded, or theaperture could be completely bounded by the flange connector panel 1846(not shown). The flange connector panel 1846 includes a slot 1856 in asidewall 1854 providing access to a sleeve portion 1848. The sidewall1854 and sleeve portion 1848 are configured to receive a portion of agripping flange 1815 of a syringe and thereby attach the connector panel1846 to the syringe. For example, the gripping flange 1815 is curved,and sleeve portion 1848 is similarly curved. This attachment could bemaintained by a friction fit, or other means. FIGS. 90 and 91 show asimilar device having an aperture 1917, where the slot 1956 providingaccess to the sleeve portion 1948 to receive a portion of the grippingflange 1915 is on another sidewall of the connector panel 1946.

In another embodiment, shown in FIGS. 92 and 93 , a flange connectorpanel 2046 comprises an aperture 2019 completely bounded by the flangeconnector panel 2046, and capable of receiving and holding a cap holderassembly. The flange connector panel 2046 includes a slot 2056 providingaccess to a sleeve portion 2048 having sockets 2049. The sockets 2049correspond in shape and location to engagement teeth 2023 on a grippingflange 2015 extending from the perimeter of the gripping flange 2015. Inthis way, when the flange connector panel 2046 is engaged with thegripping flange 2015, the engagement teeth 2023 are received by thesockets 2049 to retain the flange connector panel 2046 on the grippingflange 2015. The teeth 2023 of the gripping flange can have twodifferent sides: a gradually angled side 2029 a, farthest from theplunger 2040, and a sharply angled side 2029 b. The sockets 2049 canhave corresponding angles. The gradually angled sides 2029 a of theteeth 2023 and sockets 2049 provide for easy engagement of the connectorpanel 2046 to the gripping flange 2015, which the sharply angled sides2029 b of the teeth 2023 and sockets 2049 prevent disengagement, therebylocking the connector panel 2046 to the gripping flange 2015.

In a further embodiment, shown in FIGS. 94 and 95 , a gripping flange2115 includes a lip 2125 along its outer perimeter. A flange connectorpanel 2146 that includes an aperture 2119, a first pair of fingers 2149a, and a second pair of fingers 2149 b extending from the bottom of theconnector 2146 and configured to connect to the lip 2125 of the grippingflange 2115. The distance between the first pair of fingers 2149 a andsecond pair of fingers 2149 b could correspond to the width of the lip2125 of the gripping flange 2115, such that the first and second pair offingers 2149 a, 2149 b bear against the lip 2125 of the gripping flange2115. The first pair of fingers 2149 a could contact the top surface ofthe gripping flange 2125. The second pair of fingers 2149 b could belonger than the first pair of fingers 2149 a and comprise flanges 2151configured to extend down and contact the bottom surface of the grippingflange 2115. Additionally, as shown, the four fingers 2149 a, 2149 b arein a rectangular formation. However, the fingers could be of varyingnumbers, sizes (e.g., length or width), and/or formations, such as twofingers, six fingers, or a trapezoidal formation.

FIGS. 96 and 97 show a cap holder assembly 2220 connected to theproximal end 2242 of plunger 2240 by a frangible attachment 2236. Thefrangible attachment 2236 can be made of plastic, and a user can removethe cap holder assembly 2220 from the plunger 2240 by breaking thefrangible attachment 2236, such as by bending or twisting. In this way,the cap holder assembly 2220 could be conveniently used at a differenttime than the syringe 2210. The cap holder 2222 could have an annularprotrusion 2238 extending from its distal end 2224 and encircling thefrangible attachment 2236 to protect a user from contact and potentialinjury from the frangible attachment 2236 after breaking the frangibleattachment 2236.

FIG. 98 is a perspective view of a plunger 2340 having a receptacle 2333extending transverse to the plunger 2340. As in previous embodiments,the plunger 2340 has four support walls 2330 a, 2330 b, 2330 c, and 2330d extending at 90 degree angles with respect to each other from a commonpoint. One support wall 2330 b has a discontinuance defined by end walls2335 a and 2335 b. The support wall 2330 d on the opposite sides has aninternal recess defined by distal end wall 2335 c, lateral end wall 2335d, and proximal end wall (not shown). Transverse support walls 2330 aand 2330 c have an inner circular wall 2335 e forming an aperture thatextends through walls 2330 a and 2330 c between the discontinuance inwall 2330 b and the recess in wall 2330 d, creating a receptacle in theplunger. The receptacle is shaped to receive a cap holder assembly 2320.Arrow A illustrates the path of insertion of the cap holder assembly2320 into the receptacle in the plunger. As shown, the receptacle iscircular, but the receptacle could be a variety of shapes. The lateralend wall 2335 d of the cutout provides structure and rigidity andprevents over insertion of the cap holder assembly 2320. The cap holderassembly 2320 can be retained in the plunger 2340 by a friction fit, orother means.

Shown in FIGS. 99-101 is a plunger 2440 having a receptacle 2433 at aproximal end extending transverse to the plunger 2440. The plunger 2440has four support walls 2430 a, 2430 b, 2430 c, and 2430 d extending at90 degree angles with respect to each other from a common point. Supportwalls 2430 a and 2430 c define the receptacle 2433 and could be squareor rectangular to accommodate a square or rectangular cap holder of thecap holder assembly 2420. Arrow B illustrates the path of insertion ofthe plunger cap holder assembly 2420. Support wall 2430 b has a breakproviding clearance for engagement of the cap holder assembly 2420 withthe receptacle 2433. The support walls 2430 could include a cutoutdefining sidewalls 2435 a and a bottom wall 2435 b. As with the previousembodiment, the sidewalls 2435 a of the cutout provide clearance forengagement of the cap holder assembly 2420 with the receptacle 2433. Thebottom wall 2435 b of the cutout provides structure and rigidity to theplunger 2440 and prevents over insertion of the cap holder assembly2420. As with the previous embodiment, the cap holder assembly 2420 canbe secured in the receptacle by a friction fit, or other means.

Referring to FIGS. 102-105 , another embodiment of the present inventionis shown where a proximal end 2542 of a plunger 2540 comprises aproximal end wall 2543 having a proximal locking chamber 2547 disposedtherein. The proximal locking chamber 2547 comprises a recessed circularchamber having an oblong or oval entrance 2549. The sidewall 2545 couldinclude ribs or gripping surfaces (not shown) to facilitate handlingthereof.

The distal end 2524 of the cap holder 2522 comprises a lockingprotrusion 2588 having a circular stem 2590 and an oblong or ovallocking flange 2592 that matches the shape of the entrance 2549 of thedistal locking chamber 2547. The stem 2590 preferably has a wallthickness that matches the proximal end wall 2543 of the plunger 2540.This configuration allows the locking flange 2592 to be aligned with theentrance and inserted into the proximal locking chamber 2547. After thelocking flange 2592 is inserted into the proximal locking chamber 2547,the cap holder assembly 2520 can be rotated (e.g., 90 degrees), asillustrated by Arrow C, such that the locking flange 2592 rotates in thecircular proximal locking chamber 2547, to retain the locking flange2592 in the chamber 2547 such that the locking flange 2592 cannot bepulled therefrom because of the oblong or oval entrance 2549. A frictionfit could be provided to prevent accidental rotation/disengagement. Insuch an arrangement the cap holder assembly 2520 could lock to theplunger 2540 until it is rotated an additional 90 degrees with respectto the plunger.

Importantly, other locking flanges 2592, entrances 2549, and cutoutgeometries are contemplated, and they are not limited to solely oblongor oval geometries. Instead, the locking flange 2592 and the entrance2549 or cutout may be matching asymmetrical designs, rectangular,triangular, or any other geometric arrangement. In use, the antisepticcap 2582 could be applied while the cap holder assembly 2520 is attachedto the plunger 2540 or the cap holder assembly 2520 can be removed fromthe plunger 2540 and used separately.

Another embodiment of the present invention is shown in FIGS. 106-108 .A sidewall 2662 of a chamber 2660 of a plunger 2640 comprises a lockinglever 2664 having a proximal end 2668 and a distal end 2672, and isconnected to the sidewall 2662 by a living hinge 2666, which acts as afulcrum. The proximal end 2668 comprises a locking protrusion 2670 thatengages a groove in the cap holder 2622 of the cap holder assembly 2620,thus locking it when the cap holder 2622 is secured within the chamber2660 of the plunger 2640. By pushing on the distal end 2672 of thelocking lever 2664, the proximal end 2668 rotates about the living hinge2666, illustrated by lines D, causing the locking protrusion 2670 todisengage from the groove in the cap holder 2622, thereby allowingremoval of the cap holder assembly 2620 from the chamber 2660.

Moreover, shown in FIGS. 109 and 110 , the distal end 2772 of thelocking lever 2764 could have a toe 2773 to facilitate removal of thecap holder assembly 2720 from the chamber 2760 of the plunger 2740. Whenthe distal end 2772 of the locking lever 2764 is pressed and theproximal protrusion 2770 of the proximal end 2768 rotates about theliving hinge 2766, illustrated by lines E, and disengages from the capholder 2722, the toe 2773 pushes against the cap holder assembly 2720and the shape of the toe 2773 urges the cap holder assembly 2720 out ofthe chamber 2760, illustrated by line F.

Referring to FIG. 111 , another embodiment of the present invention isshown where a first adhesive material 2894 a is fixed to the distal end2824 of a cap holder assembly 2820 and a second adhesive material 2894 bis fixed to the proximal end 2842 of the plunger 2840 of the syringe.The two adhesive materials 2894 a, 2894 b are removably attachable toone another. The adhesive materials 2894 a, 2894 b could be any suitableadhesive or could be another type of material that can form aconnection, such as hook and loop fasteners where material 2894 a couldbe comprised of hooks, and material 2894 b could be comprised of loops.In this way, the cap holder assembly 2820 could be repeatedly attachedto the plunger 2840. Further, when the cap assembly 2820 is attached tothe plunger 2840, the cap may be removed from the cap assembly 2820,without first having to remove the cap holder assembly 2820 from theplunger 2840.

Another embodiment is shown in FIGS. 112 and 113 , where a proximal endof the plunger comprises an axially compressible material 2998, such asfoam or accordion folded plastic, defining a cavity. As shown in FIG.112 , a cap holder assembly 2920 could be inserted into the cavity, suchas by the path illustrated by Arrow G, and secured therein by thefrictional radial force of the compressible material 2998 against theouter surface 2926 of the cap holder 2922. As shown in FIG. 113 , whenthe compressible material 2998 is compressed, as illustrated by ArrowsH, the cap holder assembly 2920 is easily gripped and removed.

Referring to FIG. 114 , another embodiment of the present invention isshown. A plunger 3040 could have an annular flange 3067 at a peripheralproximal end 3066 of a chamber 3060 and a cap holder 3022 could have anannular flange 3027. When the cap holder assembly 3020 is fully insertedinto the chamber 3060 of the plunger 3040 the two flanges 3027, 3067 arespaced apart by a distance. The spaced distance allows a user to gripthe flange 3027 of the cap holder 3022, and thus easily remove the capholder assembly 3020 from the chamber 3060.

FIGS. 115-118 show another embodiment of the present inventioncomprising a radially compressible locking ring 3174 attached to aperipheral proximal end 3166 of a plunger 3140. The locking ringcomprises press tabs 3178 and diametrically opposed locking tabs 3176.As shown in FIG. 116 , the distance between the locking tabs 3176 isless than the diameter of the cap holder 3122, thus securing the capholder assembly 3120 in the chamber 3160 of the plunger 3140. When adiametrically opposed force is applied at the press points 3178, asshown by Arrows I, the locking ring 3174 deforms and the locking tabs3176 separate from each other, shown by Arrows J, sufficient to allowthe removal of the cap holder assembly 3120 from the chamber 3160 of theplunger 3140. FIG. 118 shows another embodiment of the locking ring 3274comprising locking tabs 3276 where the locking ring 3274 is generallycircular in shape, and where a force applied, illustrated by lines K,results in the tabs 3276 separating, illustrated by lines L.

From the foregoing, it will be observed that numerous variations andmodifications may be effected without departing from the spirit andscope of the invention. It is to be understood that no limitation withrespect to the specific apparatus illustrated herein is intended orshould be inferred. It is, of course, intended to cover by the appendedclaims all such modifications as fall within the scope of the claims.

What is claimed is:
 1. An antiseptic medical cap comprising: a base comprising a proximal surface and a distal surface; a sidewall extending in a distal direction from the base, the sidewall comprising a proximal end and a distal end; a chamber configured to receive a proximal end of a medical fluid port having an opening; and an insert comprising a gas-releasing anti-microbial compound, the insert extending in the distal direction, the insert being configured to be positioned at least partially through the opening of the medical fluid port when the antiseptic medical cap receives the proximal end of the medical fluid port into the chamber.
 2. The antiseptic medical cap of claim 1, wherein the insert is at least partially positioned within the chamber.
 3. The antiseptic medical cap of claim 1, wherein the chamber is at least partially defined by an inner surface extending along the distal surface of the base and the sidewall.
 4. The antiseptic medical cap of claim 1, wherein the gas-releasing anti-microbial compound is configured to release nitric oxide.
 5. The antiseptic medical cap of claim 1, wherein the gas-releasing anti-microbial compound is a coating on the insert.
 6. The antiseptic medical cap of claim 1, wherein the insert further comprises zinc.
 7. The antiseptic medical cap of claim 1, wherein the insert extends distally beyond the distal end of the sidewall.
 8. The antiseptic medical cap of claim 1, wherein the insert extends distally from the distal surface of the base.
 9. The antiseptic medical cap of claim 1, wherein an interior surface of the antiseptic medical cap comprises threads being configured to mate with corresponding threads on the medical fluid port.
 10. A combination of the antiseptic medical cap of claim 1 and the medical fluid port.
 11. The combination of claim 10, wherein the medical fluid port is an access site with a valve.
 12. The combination of claim 11, wherein the insert is a post configured to open the valve of the access site when the medical fluid port is received within the chamber of the antiseptic medical cap.
 13. An antiseptic medical cap comprising: a base; a sidewall extending in a distal direction; a chamber being sized and shaped so as to be capable of receiving a proximal end of a fluid port having an opening; and a nitric oxide-releasing system being configured to be at least partially inserted through the opening of the fluid port as the proximal end of the fluid port is received into the chamber.
 14. The antiseptic medical cap of claim 13, wherein an inner surface of the antiseptic medical cap comprises threads configured to mate with corresponding threads on the fluid port.
 15. The antiseptic medical cap of claim 13, wherein the nitric oxide-releasing system includes a compound comprising zinc.
 16. The antiseptic medical cap of claim 13, wherein the nitric oxide-releasing system comprises a post extending in the distal direction.
 17. The antiseptic medical cap of claim 16, wherein the nitric oxide-releasing system comprises a coating on the post.
 18. A combination of the antiseptic medical cap of claim 13 and the fluid port.
 19. The combination of claim 18, wherein the fluid port is an access site with a valve.
 20. The combination of claim 19, wherein the nitric oxide-releasing system is a coating on a post, and wherein the post is configured to open the valve of the access site when the fluid port is received within the chamber of the antiseptic medical cap. 